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Abstract
Problem & Purpose: Spinal-induced hypotension is a common side effect of spinal anesthesia that compromises uterine blood flow and fetal circulation, subsequently leading to fetal hypoxia, bradycardia, and acidosis. The general practice in the labor and delivery operating room at a community hospital in Maryland was to administer ondansetron after spinal anesthesia. This has contributed to a 20% incidence of spinal induced hypotension in the obstetric population. The purpose of this quality improvement project was to implement and evaluate the compliance of the use of four milligrams of intravenous ondansetron five minutes prior to spinal anesthesia to reduce the incidence of spinal-induced hypotension. Methods: Key stakeholders and change champions were mobilized to aid in the successful implementation of this project. Two educational sessions were held in person for 24 anesthesia providers including six anesthesia technicians on the current evidence of spinal-induced hypotension, project goals, and workflow changes. Eligible participants included parturients undergoing elective cesarean sections with no contraindications to spinal anesthesia or ondansetron. The anesthesia providers administered and documented four milligrams of ondansetron five minutes prior to spinal anesthesia and documented if parturients experienced spinal-induced hypotension. Data was collected weekly via chart audits to assess project goals. Results: Over 15 weeks, 38 cesarean sections were performed. A total of 32 parturients received four milligrams of ondansetron prior to spinal anesthesia, achieving an overall compliance rate of 84.2%. Of these 32 parturients, 54.3% did not experience spinal-induced hypotension. Conclusion: Findings suggest that implementation of a spinal-induced hypotension evidence-based protocol was feasible at the project site. It was a cost-effective intervention that reduced the incidence of spinal-induced hypotension and improved patient outcomes with minimal workflow changes.Identifier to cite or link to this item
http://hdl.handle.net/10713/22877Collections
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