Westphal C, Barsch B. Simulating Local Anesthesia Systemic Toxicity (LAST) to improve peri-anesthesia nursing knowledge. Evidence-Based Practice poster presented at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.
Evidence-Based Practice poster presented at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.
Background Information: The use of local anesthetics to improve pain management and patient outcomes during the perioperative experience has been increasing. LAST is a rare, time sensitive, and life-threatening complication of administering local anesthetics to patients. It is important that a LAST crisis is recognized and treated immediately to have better patient outcomes.
- Increase the perianesthesia nurse’s knowledge and comfort level with LAST with education and simulation case study
- Provide resources and access for treating LAST, which include the American Society of Regional Anesthesia and Pain Medicine (ASRA) checklist for the treatment of LAST
Implementation Plan: An evidence-based literature review was conducted to develop education for the perianesthesia department. After the anesthesiologist reviewed and approved the presentation, a case study was developed for a high-fidelity simulation-based learning with debriefing session. The team partnered with pharmacy to make sure that lipid emulsion therapy was accessible in each department with the necessary supplies. The ASRA checklist was also displayed in the same location near the lipid therapy.
Outcomes: There was 100% participation with an improvement in a knowledge-based test and comfort rating scale pre- and post-intervention with an average of 58.4% to 93.8% and 4.8 to 8.4 (scale: 0-10), respectively. Shortly after the education, a patient in PACU presented with mild symptoms of LAST post nerve block with metallic taste, perioral numbness, and progressing to tremors. The nurse recognized the symptoms, notified anesthesia, and initiated treatment, which resulted in a positive patient outcome. The nurse stated that the education helped her recognize the LAST crisis, escalate, and treat the patient. A year later, a case study competency was developed and successfully completed by nursing to ensure sustainability of education.
Implications for practice: By implementing best practice, the team was able to improve knowledge and comfort of the nursing staff in recognizing and treating LAST to improve patient outcomes.