Opioid-sparing Anesthesia in Cardiac Surgery: Discovering Certified Registered Nurse Anesthetist Barrier to Implementation

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Mariah B. Best (Creator)
Institution
The University of North Carolina at Greensboro (UNCG )
Web Site: http://library.uncg.edu/
Advisor
Terry Wicks

Abstract: Background: Opioids have been heavily used in cardiac surgery for decades and continue to be the mainstay in cardiac anesthesia despite their adverse effects. Priority has been placed on improved clinical outcomes and increased patient satisfaction scores with a value-based healthcare system. This has led to more Enhanced Recovery after Surgery Programs (ERAS), with opioid-sparing anesthesia (OSA) techniques pivotal to their success. Recently, these programs have been introduced to the cardiac surgery population. However, many anesthesia providers are reluctant to implement OSA techniques in this setting. Purpose: This project sought to assess the knowledge and attitudes of Certified Registered Nurse Anesthetists (CRNAs) on opioid-sparing anesthesia techniques in cardiac surgery and identify barriers to the implementation of opioid-sparing techniques at a level I trauma center. Methods: A qualitative pre-intervention and post-intervention online survey research design was used for this project. The pre-intervention survey assessed the existing knowledge and attitudes of CRNAs. An evidence-based educational intervention was created and presented to the CRNA staff based on the results of the pre-intervention survey. The post-intervention survey assessed the remaining barriers to the adoption of opioid-sparing anesthesia techniques in cardiac surgery. Results: Based on the post-intervention survey results, the OSA techniques in cardiac surgery educational intervention did decrease barriers to implementation. Key barriers identified were the lack of regional anesthesia techniques utilized due to 1) Regional techniques not being performed in this patient population 2) Time limits for training in regional techniques 3) Lack of buy-in from anesthesiologists and cardiac surgeons for implementing regional anesthesia techniques. Recommendations and Conclusion: An assessment of the knowledge and attitudes of CRNAs regarding OSA in cardiac surgery, followed by an educational intervention was successful in identifying barriers to the adoption of OSA. Additional CRNA staff and physician education, coupled with organizational policy changes could increase the provision of regional anesthesia techniques and increase the adoption of opioid-sparing anesthesia techniques at this institution.

Additional Information

Publication
Dissertation
Language: English
Date: 2022
Keywords
CRNA, opioid-sparing, barriers

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TitleLocation & LinkType of Relationship
Opioid-Sparing Anesthesia in Cardiac Surgery: Discovering Certified Registered Nurse Anesthetist Barriers to Implementation [Poster]https://libres.uncg.edu/ir/uncg/f/M_Best_Poster_2022.pdfThe described resource includes the related resource either physically or logically.