PERIOPERATIVE ANESTHESIA MANAGEMENT OF SURGICAL PATIENTS WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES

Abstract

Problem Statement: Currently, in the United States, there are approximately 3 million patients with Cardiovascular Implantable Electronic Devices (CIEDs). Annually, more than 1 million CIEDs are implanted and 2% of patients with CIEDs undergo cardiac/non-cardiac surgical procedures. With the increase in surgical patients with CIEDs, CIED variations and CIED risk of complications, anesthesia providers must have current knowledge about preoperative and postoperative management of this patient population. Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to develop an evidence-based clinical practice guideline (CPG) for standardizing the preoperative and postoperative anesthesia management of surgical patients with CIEDs at a large, teaching, level two trauma hospital in Baltimore, Maryland. Currently, there is no existing evidence-based practice for anesthesia management of these patient populations at this facility which provided an educational opportunity to improve patient safety. Methods: An expert panel was convened and included two Certified Registered Nurse Anesthetists (CRNAs), one anesthesiologist, an interventional cardiologist, and a chief information officer. A comprehensive review of literature was conducted. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) Tool was utilized by the expert panels to assess the quality of the CPG. After the dissemination of the CPG via an educational PowerPoint presentation to anesthesia providers at Grand Rounds, the practitioner feedback questionnaire (PFQ) was completed. The PFQ is a 3-point Likert-scale used to assess the accuracy and transparency of the development of the CPG. Results: The domain scores of the AGREE II tool ranged from 70 to 100%. The domain “Editorial Independence” rated highest with a score of 100%. The domain “Stakeholder Involvement” rated lowest with a score of 70% and “Applicability” with a score of 81%. 80% of anesthesia providers (n=30) completed PFQ. Overall, 94% of the anesthesia providers agreed that the guideline should be approved for practice and it would be applied in their practice. Conclusion: This CPG impacted the knowledge deficit among anesthesia providers at this facility to increase awareness and improve patient safety of surgical patients with CIEDs. Even though this CPG was designed based on the need of this institution’s anesthesia providers, stakeholders permitted the application and usability of this CPG at other sister hospitals under this facility’s health system.