Date of this Version

2024

Document Type

DNP Project

Abstract

Background: Neuraxial anesthesia has revolutionized pain management during childbirth and surgical procedures by offering effective pain relief. However, along with its benefits, potential complications can be encountered. A major common complication following lumbar puncture involves accidental puncture of the dura, triggering a post-dural puncture headache (PDPH). PDPH represents a noteworthy concern within the realm of anesthesia, manifesting after specific procedural intervention, with a notable predilection involving particularly spinal or epidural anesthesia. This quality improvement project aimed to elevate the post-dural puncture headache treatment standard. Thus, the project aimed to use neostigmine and atropine in treating PDPH due to the drugs’ mechanism of action and effectiveness.

Method: The blind quality improvement project started with a literature review that compared the use of neostigmine and atropine, and an epidural blood patch (EBP) showed the effectiveness of neostigmine and atropine in treating PDPH after spinal anesthesia. The potential number of participants in the project includes 10 CRNAs and anesthesiologists working within the maternity departments. These anesthesia providers will be involved in an educational intervention on the effectiveness of neostigmine and atropine. The QI project used the one-group pre-intervention post-intervention quasi-experimental study design. Methods of data and information collection included the use of questionnaires. The questionnaires, as a form of survey, were given to the providers to fill out before and after the education.

Results: Ten participants (n = 10) consented to participate in an educational module. After completing the educational module, the providers’ understanding of PDPH and knowledge of treatment/management utilizing neostigmine and atropine strategies validated an increase in correct responses when comparing the pre-test and post-test interventions. The results assessed the knowledge gained in providers’ awareness of new evidence-based practice when addressing PDPH with neostigmine and atropine versus an EBP.

Discussion: The educational module was a quality improvement project designed to elevate the PDPH treatment and management standard. The data collected shows a percent increase in comprehension of neostigmine and atropine’s mechanism of action in the choroid plexus. A key outcome is the 900% increase in awareness of the new evidence-based practice for PDPH treatment abstaining from EBP. Some limitations include the small sample size (n = 10) despite the invited participants to participate (n = 40) in the QI project. However, there is a favorable relationship between the knowledge obtained and concurring towards implementing innovation.

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