Barriers to Remifentanil Use for Labor Analgesia: A Process Improvement Initiative
Abstract
Problem/Issue: Neuraxial analgesia is the gold standard for labor analgesia, but is contraindicated in some parturients. Patient-controlled intravenous administration of remifentanil (PCIAR) offers analgesia using an ultra-short acting opioid agonist; however, barriers, including staff knowledge deficits and limited logistical support, limited its use at our facility. Purpose: The purpose of this project was to remove barriers to the appropriate use of remifentanil at our hospital. Project Design: A pre- and post-implementation process improvement approach was utilized based on the Plan, Do, Study, Act Model at Naval Medical Center Portsmouth. A systematic literature review was conducted to determine best practices for safe and effective use of remifentanil in laboring parturients and surveys were disseminated to identify barriers. An updated standard operating procedure (SOP), including revised order sets, was developed through collaboration with stakeholders (anesthesia, obstetrics, and pharmacy). It reflected current best practices and addressed barriers identified in the pre-survey. An education plan was designed based on the updated SOP and disseminated to target groups. Pre and postimplementation knowledge assessments were utilized to assess effectiveness of training and removal of barriers through project implementation. Analysis of the Results: Identified barriers to successful implementation were: staffing and time constraints, knowledge deficits, and equipment concerns. After implementation of the updated SOP and training, anesthesia and obstetrical staff demonstrated substantially improved knowledge about the safe use of PCIAR. Post-implementation knowledge assessments also indicated increase in knowledge of PCIAR, as well as a better understanding of the updated SOP. Organizational Impact: When utilized properly, PCIAR is a safe and effective alternative for labor pain in women who are ineligible for neuraxial analgesia.
Document Details
- Document Type
- Technical Report
- Publication Date
- Sep 01, 2017
- Accession Number
- AD1128213
Entities
People
- Cassy Piela
- Sharrod Greene
- Stephanie Daniels
Organizations
- Uniformed Services University of the Health Sciences