Hypotension: Preventing the Fall
Title: Hypotension: Preventing the Fall
- Identify variables that may contribute to hypotension post-epidural.
- Discuss strategies to improve post-epidural hypotension rates.
- Strengthen collaboration between RN's and Anesthesia providers.
The staff in Labor & Delivery at Baylor University Medical Center noticed an increased incidence of hypotension following epidural placement requiring ephedrine for treatment. Data collection began to determine if the perception was accurate and if there were recognizable patterns. Initial surveys evaluating knowledge regarding hypotension were given to various nurses on each shift. Additionally, sixty-nine retrospective random chart audits were conducted evaluating baseline blood pressure before and after epidural placement, as well as the use of ephedrine to treat hypotension. Our initial data suggested both a staff knowledge deficit, and a post-epidural hypotension rate of 22.67%.
Proposed change: 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 post-epidural 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 utilization of order sets, we developed and provided educational in-services. The in-services focused on potential exaggerating or precipitating factors, prevention and corrective measures of post-epidural hypotension. We also focused on improving communication between RN’s and anesthesia providers, empowering the RN’s to ask more questions regarding procedure type, medications given, and timing and amount of pre-load vs. co-load. Additionally, our documentation system was revised to facilitate improved documentation of interventions including IV 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 RN’s and Anesthesia providers, BUMC’s hypotension rate in the obstetric population decreased from 22.67% to 8%.
Implications for nursing practice: While literature states that hypotension affects up to 80% of parturient women, with efforts focused on prevention, recognition and early intervention, we aim to decrease the incidence of maternal/fetal response and promote safe passage.
Keywords: epidural, hypotension, standardized education