Increasing Confidence of Certified Registered Nurse Anesthetists in Managing an Amniotic Fluid Embolism – A Quality Improvement Project

Abstract

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.