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Access status: Open Access ,
Local Anesthetic Systemic Toxicity: A DNP Project
(2025-11-30) Courtney D. Dilao
The incidence of local anesthetic systemic toxicity (LAST) is approximately two out of 1,000 peripheral nerve blocks and approximately one out of 1,000 epidurals. The purpose of this quality improvement project is to assess Certified Registered Nurse Anesthetists (CRNAs’) perceptions of the adequacy of a LAST Quick Reference Guide (QRG) designed to assist in identifying high-risk patients to quickly diagnose and appropriately treat LAST should it occur. The project site does not currently have a LAST QRG or policy in place. After formulating a PICOT question, a team of student registered nurse anesthetists (SRNAs) developed a QRG and presentation to be individually presented and implemented at different project sites. Each student having individual data and analysis points. This paper discusses this author’s plan, implementation, data results, and analysis. After utilizing the QRG for two weeks. CRNAs reported improved awareness of LAST and improved confidence level in diagnosing and treating a LAST crisis, should it occur. The majority of participants are in favor of the use and implementation of a QRG at the project site. These results show that QRG on LAST would be beneficial to implement in the clinical setting at the project site. This project could be a steppingstone for this project site or other facilities to implement a QRG on LAST at their location. Limitations include a small sample size, locum staff, and lack of this author’s physical presence at one of the two project sites.
Access status: Open Access ,
Local Anesthetic Systemic Toxicity Prevention Recognition and Treatment in a Perioperative Setting: A Quality Improvement Project and DNP Project.
(2025-11-30) Henderson, Dalton
Local and regional anesthesia provides a benefit to patients in the perioperative period by allowing for surgical procedures to be performed, preventing and treating post-operative pain, and suppressing pain for up to three days. Local Anesthetic Systemic Toxicity (LAST) is a potentially fatal complication of inadvertent systemic absorption of local anesthetics. CRNAs have a crucial role in administering local anesthesia and preventing or treating LAST. The purpose of this DNP QI project was to develop and assess CRNA perceptions of a new quick reference guide (QRG) on LAST treatment and prevention. This quality improvement project was conducted in the main operating room area of a level one trauma hospital in Eastern United States. A single Plan-Do-Study-Act cycle was completed employing a pre- and post-implementation survey design that assessed CRNAs’ perception of the QRG. The CRNAs reported an overall positive perception of the QRG. Most of the CRNAs responded that the BICEPSS mnemonic was useful. There was a generalized increase in confidence of knowing maximum dosages of local anesthetics when the QRG was used. Most of the CRNAs supported implementation of the QRG, or one like it, at the partnering organization. Limitations of the study included small sample size, and unique division of the anesthetic workload at the partnering organization. Recommendations for future QI projects in this area include individualized QRG development for the organization, a larger sample size, and involvement of non-CRNA anesthesia providers.
Access status: Open Access ,
Increasing Confidence of Certified Registered Nurse Anesthetists in Managing an Amniotic Fluid Embolism – A Quality Improvement Project
(2025-11-30) Michaela Brooke Davenport
Amniotic fluid embolisms (AFE) are a rare obstetrical emergency with high mortality in the gravid patient and fetus, increasing both healthcare costs and stress for the patient, their family, and the provider. Data regarding AFE events are inconclusive, leaving CRNAs to rely on clinical judgment during this obstetrical emergency. The purpose of this quality improvement project is to assess whether the creation of a newly developed cognitive aid increased the confidence of CRNAs in identifying and managing an AFE event. A literature review was conducted to gather current recommendations on AFE events and the use of cognitive aids in anesthetic practice. A cognitive aid was then developed to illustrate the recommended steps for identifying and managing AFE events. The cognitive aid and current literature were presented to the CRNAs before their shift at a critical access hospital in Northeastern North Carolina. The participants (n = 3) completed both a pre- and post-presentation survey to gauge their thoughts on the tool and determine whether they perceived an increase in confidence. During data comparison, the use of a cognitive aid increased CRNA confidence in identifying and managing AFE events. An increase in CRNA confidence when using the tool will help reduce the likelihood of missing critical steps during an AFE event. However, due to the small sample size, further research is needed on the topic. Future research on AFE events can increase CRNA confidence while decreasing mortality for the fetus and parturient.