A Quality Improvement Project to Prevent Spinal-Induced Hypotension

Abstract

Problem& Purpose: At an acute care teaching hospital in Washington D.C., adult patients undergoing elective surgery for total joint replacements are anesthetized via spinal anesthesia. This anesthetic provides adequate analgesia and decreased sensation at the surgical site, however, over 60% of patients experience spinal-induced hypotension. Hypotension can give rise to many complications such as anoxic brain injury, kidney injury, and delayed wound healing subsequently increasing hospital costs and length of stay. Despite multiple interventions used to mitigate this, its occurrence at this hospital was double the incidence found in published studies. The purpose of this Doctor of Nursing Practice quality improvement project was to implement and evaluate compliance with the evidence-based administration of ondansetron 4 milligrams intravenously five minutes prior to spinal anesthesia. Methods: A team of key stakeholders and change champions was mobilized to identify barriers and facilitators and foster implementation. Education was provided to all anesthesia providers to administer ondansetron 4 milligrams within five minutes prior to spinal anesthesia and document administration. Using the Compliance of Ondansetron Administration Tool, retrospective data were collected and analyzed weekly for all eligible patients. Run charts were created to examine for runs, shifts, and trends over the 14-week implementation period. Results: Results show that of 176 eligible patients, over 53% received ondansetron. Over 75% of patients who received ondansetron prior to spinal anesthesia did not experience spinal-induced hypotension. Conclusions: Findings suggest that the administration of ondansetron 4 milligrams within five minutes prior to spinal anesthesia is feasible and sustainable at the project site. Overall, this quality improvement project remarkably prevented the incidence of spinal-induced hypotension among patients at this hospital.