Assessing CRNA Perceptions of a Cognitive Aid Regarding Local Anesthetic Systemic Toxicity: A DNP Quality Improvement Project

Abstract

Local anesthetic systemic toxicity (LAST) is a rare but potentially catastrophic complication of local anesthetic administration in the perioperative and operative setting. The purpose of this Doctor of Nursing Practice (DNP) quality improvement project is to assess CRNA perceptions of the adequacy of a LAST Quality Reference Guide designed to assist in identifying high-risk patients to quickly diagnose and appropriately treat LAST should it occur. The setting of this QI project was an outpatient surgery center located in the southeastern United States. Five of seven CRNAs participated in this quality improvement project over a two-week implementation period. Key components of the project were the creation, implementation, and evaluation of CRNAs’ perceptions of the LAST Quality Reference Guide (QRG). The guide summarizes current evidence-based guidelines for LAST management and was introduced through a narrated PowerPoint Presentation to participants via email. A pre-implementation survey and a post-implementation survey were administered to participants. The results of this quality improvement project were positive. All participants who responded to the surveys agreed that the QRG and project implementation increased their awareness of LAST. No recommendations were made to improve the QRG. A major limitation of this project was the small sample size. Subsequent iterations of this quality improvement project should include a larger sample size for a longer implementation period to obtain data that may be generalizable in a larger hospital setting.