Local Anesthetic Systemic Toxicity Prevention Recognition and Treatment in a Perioperative Setting: A Quality Improvement Project and DNP Project.

Abstract

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.