Improving Labor Neuraxial Analgesia by Reducing Anesthesia Provider Practice Variance Involving Routine Platelet Counts: A Quantitative Quality Improvement Project

Abstract

For this quality improvement (QI) project, the desired outcomes were the reduction of the incidences of withheld neuraxial analgesia (NA) for healthy parturients and the adoption of evidence-based practice (EBP) by the anesthesia providers (APs). The practice change was designed using the diffusion of innovations in health service organizations change model. The 3 interventions used to achieve the outcomes of the project were (a) revision of the anesthesia service’s standard operating procedure (SOP) to incorporate recent recommendations addressing platelet count limits for parturients, (b) addition of a clinical decision reminder in the patient’s electronic medical record (EMR), and (c) educating obstetrical APs about the new SOP and updated EMR.Outcomes were measured using pre- and postimplementation surveys of the staff who work on the labor and delivery ward to evaluate AP practice variance and a modified EBP Implementation Scale to measure the adoption of the evidence by the APs. The QI project was successful in reducing practice variance and resulted in fewer incidences of withheld NA for healthy parturients, and 57.1% of the APs reported changing their practice by adopting the evidence for this project.