Local Anesthetic Systemic Toxicity: A DNP Project

Abstract

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.