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Improving Patients’ experience undergoing Spinal Anesthesia for cesarean delivery: A quality Improvement initiative
Abstract Number: F-02
Abstract Type: Original Research
Introduction: Cesarean delivery (CD) is one of the most common operations in North America and the incidence is increasing 1. It is most commonly carried out using spinal anesthesia (SA) 2 . The rate of CD at our tertiary care academic obstetric center is 22%. Therefore, an understanding of patients’ experiences with SA is warranted. We conducted a quality improvement initiative to the patients’ experience undergoing SA for CD, using the Plan-Do-Study-Act (PDSA) methodology.
Methods: REB approval and written informed consent was obtained from all participants in this study. Using a written, Likert scale questionnaire we surveyed thirty (n=30) healthy, pregnant patients at term gestation with single fetuses who had undergone elective CD with SA to ascertain the incidence of bothersome events (See Appendix 1) to determine our baseline data. Our questionnaire showed 40% of patients found shivering was the most bothersome event. Consequently, we conducted targeted interventions using the PDSA methodology to improve the rate of shivering. For PDSA cycle 1 we introduced forced air warming, PDSA cycle 2 we implemented intravenous fluid warming, and for PDSA cycle 3 we used to a circulating heat mattress. We used a convenient sample to survey patients after each PDSA cycle to see if our interventions demonstrated any improvement in shivering. We aim to survey 30 patients per PDSA cycle.
Results: To date, 94 patients have been surveyed and all patients received the intended intervention during the PDSA cycles. After implementing PDSA cycle 1, the incidence of bothersome shivering decreased from 40% at baseline to 32% . In PDSA cycle 2, shivering was reduced substantially to 13% . Results from our third intervention (PDSA cycle 3) are pending.
Discussion: This QI project highlighted an important aspect of the patients’ experience following SA for CD, the bothersome event of shivering. We have used targeted interventions to successfully decrease this side effect. These interventions may make a meaningful impact and improvement in our patients’ experience of SA for CD.
1-Am J Obstet Gynecol 2005; 193:1607-17
2- Anesthesiology 2005; 103:645-53
3- Br J Anaesth 2015; 115 (4): 500–10