Date of Award

Spring 5-1-2022

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Advisor

Dr. Brian Garrett

First Committee Member

Dr. Kacy Ballard

Second Committee Member

Dr. Greg Stockton

Keywords

Anesthesia, Opioid Sparing, TAP Block, Lidocaine Infusion, ERAS, Compliance, Quality Improvement

Subject Categories

Medicine and Health Sciences

Abstract

In light of the current opioid epidemic in the United States, multiple sectors of health care specialties and nursing leaders have been called to aide in reversing this deadly opioid abuse trend. As a team, Certified Registered Nurse Anesthetists (CRNA), surgeons, and anesthesiologists have made great strides in developing evidence-based protocols titled Enhanced Recovery After Surgery (ERAS). ERAS protocols vary according to the surgical specialty; however, one universal component includes opioid sparing techniques such as peripheral nerve blocks. Despite ERAS protocol’s benefits throughout the perioperative period, according to the literature, many anesthesia groups across the nation are non-compliant with their protocols due to lack of “buy- in” and resistance to change traditional practice.

In particular, at a mid-size urban hospital, it was reported by key stakeholders that anesthesia providers are not compliant with the facility’s gynecology ERAS protocol which promotes opioid sparing techniques such as transverse abdominal plane (TAP) blocks/lidocaine infusions. The Gynecology Surgery ERAS protocol at this medical center was implemented in June of 2019. A six-month audit of gynecological surgeries between July and November of 2019, revealed that only 67 percent of the gynecology surgeries cases utilized TAP blocks or lidocaine infusions, indicating a possible clinical gap in practice. Prior to this project, reasons for lack of compliance with ERAS use of TAP blocks and lidocaine infusion administration among anesthesia providers was unknown.

The purpose of this project was to identify the key reasons anesthesia providers were not utilizing the established ERAS guidelines and provide recommendations to the leadership that had authority to mitigate this issue and improve clinical practice of anesthesia providers caring for gynecology surgical patients.

Licensing Permission

Copyright, all rights reserved. Fair Use

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.