Development, implementation, and evaluation of a preoperative peripheral nerve block and sedation protocol

Purpose of Project: A peripheral nerve block (PNB) is a key contributor in pain management related to surgery but is also associated with potential risks. Standard guidelines recommend continuous monitoring and assessment for patients who receive anesthesia and sedation. Settings where PNBs take place outside of the operating room fall behind these recommendations. This quality improvement project aimed to improve patient monitoring and assessment of patients receiving a preoperative PNB with sedation by implementing an evidence-based protocol. The protocol focused on the steps, complications, assessment and care, documentation, anesthesia notification, and additional information related to PNBs. Methodology: Preoperative nurses were educated using an educational module. A retrospective chart review was used to collect data on nursing documentation compliance to the protocol four weeks before and four weeks after the implementation. Nurses were given an anonymous post-survey on protocol effectiveness/intent after the intervention took place. Results: Pre-implementation charts (25) were compared to post-implementation charts (21). There was statistical significance in pain scale (p-value = 0.031), cardiac monitor (p-value = 0.006), sedation scale (p-value= 0.0027), and peripheral vascular assessment (p-value <0.0001) documentation categories. Statistical significance was not observed in vital signs documentation (p-value of 0.11), but clinical significance was. There was statistical significance in combined documentation (p-value of