Reducing Spinal Induced Hypotension Among Adult Orthopedic Patients
AuthorWardrop, Rachael A.
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AbstractProblem: Orthopedic patients frequently receive intrathecal anesthesia as the primary form of anesthesia. A side effect of intrathecal anesthesia is spinal induced hypotension which can lead to decreased perfusion to vital organs and necessitate the use of increased fluids and vasopressors. In a community hospital located in Baltimore, Maryland approximately 80% of orthopedic surgical patients experience hypotension after intrathecal anesthesia. Purpose: The purpose of this Doctor of Nursing Practice quality improvement project is to achieve 100% compliance with administering 4 mg of ondansetron five minutes prior to intrathecal anesthesia to reduce the incidence of hypotension in orthopedic patients at community hospital in Maryland. Methods: Key stakeholders and change champions were mobilized to facilitate implementation. Interventions included in-person education sessions, placement of visual aids, and placement of quick response codes with links to education. Anesthesia providers administered 4 mg ondansetron intravenously five minutes prior to intrathecal anesthesia. Data was collected weekly through retrospective chart reviews. Results: Findings yielded a total of 179 different data points over 14 weeks. When examining the trend in data over time, the first week had 0% compliance followed by an upward trend to 93.7% compliance in week 12. Pre-implementation rate of patients not experiencing hypotension was 20% and during implementation the average rate of patients not experiencing hypotension increased to 60%. Conclusions: Findings suggest that utilizing tailored implementation strategies and tactics based on the needs of the clinical site significantly increased compliance with implementation of administering ondansetron. Overall, a decrease in rate of spinal induced hypotension at clinical site was seen, suggesting patient outcomes can be improved.
Rights/TermsAttribution-NonCommercial-NoDerivatives 4.0 International
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/20877
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Except where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivatives 4.0 International