Purpose for the Program
The staff in the labor and delivery (L&D) unit at Baylor University Medical Center noticed an increased incidence of hypotension after epidural placement, which required ephedrine for treatment. Data collection began to determine if the perception was accurate and if there were recognizable patterns. Initial surveys that evaluated knowledge regarding hypotension were given to various nurses on each shift. Additionally, 69 retrospective random chart audits were conducted, which evaluated baseline blood pressure before and after epidural placement and evaluated the use of ephedrine to treat hypotension. Our initial data suggested a staff knowledge deficit and a postepidural hypotension rate of 22.67%.
The L&D Comprehensive Unit-Based Safety Program (CUSP) felt this data reflected a quality improvement opportunity. Based on our process modeling flow chart and fishbone diagram, we developed a goal to reduce postepidural hypotension in the obstetric patient population by 5% with the implementation of nursing education and clarification of order sets.
Implementation, Outcomes, and Evaluation
To correct the knowledge deficit and inconsistent use of order sets, we developed and provided educational in-services. The in-services focused on potential exaggerating or precipitating
factors and the prevention and corrective measures of postepidural hypotension. We also focused on improving communication between registered nurses (RNs) and anesthesiologists, empowering the RNs to ask more questions regarding procedure type, medications given, timing, and amount of preload versus co-load. Additionally, our documentation system was revised to facilitate improved documentation of interventions, including intravenous fluid bolus timing and amount. Biweekly random chart audits were performed to evaluate progress and percentage of hypotension. Through standardized education and improved collaboration between RNs and anesthesiologists, Baylor University Medical Center's hypotension rate in the obstetric population decreased from 22.67% to 8%.
Implications for Nursing Practice
Though literature states that hypotension affects up to 80% of parturient women, we aim to decrease the incidence of maternal/fetal response and promote safe passage with efforts focused on prevention, recognition, and early intervention,