Recommended Citation
Adams B, Martinez K, Poelking E, Renick Y. Using nursing judgement to reduce postpartum fall rates in patients recovering from epidural analgesia. Quality Improvement poster presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Presentation Notes
Quality Improvement poster presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Abstract
Background: Epidural analgesia is the most common type of anesthetic used for pain relief during labor. By injecting a medication mixture into the lumbar epidural space, a sensory nerve block is created from the umbilicus to the top of the legs, virtually eliminating pain. However, this also produces a motor block, which can be especially pronounced when certain medications, like bupivacaine, are used. Consequently, postpartum patients who are recovering from epidural analgesia are at greater risk for falls when ambulating.
Local problem: In December 2021, a hospital with a high-volume inpatient obstetrics department experienced an epidural medication formulary change and began using bupivacaine. Subsequently, the hospital’s postpartum (PP) unit observed a marked increase in patient falls. NDNQI data revealed that fall rates increased from 0.00 patient falls per 1,000 patient days for both Q3 and Q4 of 2021 to 1.66 and 1.28 for Q1 and Q2 of 2022, respectively.
Method: The PP unit falls champion, unit educator, and site nursing director decided on a simple solution: increase PP nurses’ awareness of the epidural formulary change and subsequent increase in falls and rely on PP nurses to utilize nursing judgment and respond accordingly. Increasing situational awareness was achieved by having charge nurses make announcements twice daily during pre-shift nursing huddles.
Results/Conclusions: Following the intervention, falls decreased to 0.27 patient falls per 1,000 patient days for Q3 of 2022 and 0.32 for Q4 of 2022.
Implications for practice: Nursing judgment (the culmination of education, experience, and insight that allows nurses to execute the best action possible on behalf of patients) is a skill employed in everyday practice. Because this project relied on internal ability rather than on an external intervention, its sustainability is virtually unlimited. Although closer and more organized study is needed, the implications of this idea for nursing practice could be hugely influential in terms of resource management.
Document Type
Poster
Publication Date
11-15-2023
Using nursing judgement to reduce postpartum fall rates in patients recovering from epidural analgesia
Background: Epidural analgesia is the most common type of anesthetic used for pain relief during labor. By injecting a medication mixture into the lumbar epidural space, a sensory nerve block is created from the umbilicus to the top of the legs, virtually eliminating pain. However, this also produces a motor block, which can be especially pronounced when certain medications, like bupivacaine, are used. Consequently, postpartum patients who are recovering from epidural analgesia are at greater risk for falls when ambulating.
Local problem: In December 2021, a hospital with a high-volume inpatient obstetrics department experienced an epidural medication formulary change and began using bupivacaine. Subsequently, the hospital’s postpartum (PP) unit observed a marked increase in patient falls. NDNQI data revealed that fall rates increased from 0.00 patient falls per 1,000 patient days for both Q3 and Q4 of 2021 to 1.66 and 1.28 for Q1 and Q2 of 2022, respectively.
Method: The PP unit falls champion, unit educator, and site nursing director decided on a simple solution: increase PP nurses’ awareness of the epidural formulary change and subsequent increase in falls and rely on PP nurses to utilize nursing judgment and respond accordingly. Increasing situational awareness was achieved by having charge nurses make announcements twice daily during pre-shift nursing huddles.
Results/Conclusions: Following the intervention, falls decreased to 0.27 patient falls per 1,000 patient days for Q3 of 2022 and 0.32 for Q4 of 2022.
Implications for practice: Nursing judgment (the culmination of education, experience, and insight that allows nurses to execute the best action possible on behalf of patients) is a skill employed in everyday practice. Because this project relied on internal ability rather than on an external intervention, its sustainability is virtually unlimited. Although closer and more organized study is needed, the implications of this idea for nursing practice could be hugely influential in terms of resource management.
Affiliations
Aurora West Allis Medical Center & Aurora Women's Pavilion