Preventing Spinal Induced Hypotension in the Obstetric Population

Abstract

Problem & Purpose: At a Baltimore, Maryland hospital 50% of parturients undergoing elective cesarean sections experienced spinal induced hypotension. Spinal induced hypotension has maternal and fetal adverse effects. Despite performing a substantial percentage of cesarean sections each year, the facility lacked a standardized protocol to prevent this complication. The purpose of this Doctor of Nursing Practice Quality Improvement Project was to achieve 100% compliance with administration of 4mg ondansetron five minutes prior to spinal anesthesia, in parturients undergoing elective cesarean sections, to reduce the incidence of spinal induce hypotension. Methods: Key stakeholders and change champions were mobilized. Anesthesia providers were educated and provided current literature supporting prophylactic administration of ondansetron, prior to spinal anesthesia, decreases the incidence of spinal induced hypotension. Each patient deemed eligible received 4mg ondansetron five minutes prior to spinal administration. Data was collected via chart audits over 15 weeks. Results: A total of 48 patients were included in the project data. 35 patients received 4mg ondansetron prior to spinal anesthesia, achieving an overall compliance rate of 73%. Of these 35 patients, 74% did not experience spinal induced hypotension. Conclusions: The project proved feasible at the project site. Dissemination of evidence-based practice, on compliance with the initiative and incidence rates of spinal induced hypotension, increased buy-in from anesthesia providers to produce practice change. Findings align with current literature demonstrating ondansetron’s effectiveness in reducing the incidence of spinal induced hypotension. Results were disseminated at the 2023 Maryland Association of Nurse Anesthetists Spring Webinar and the 2023 University of Maryland School of Nursing Doctor of Nursing Practice Poster Day.