Implementing Evidence-Based Practice Guidelines for the Anesthetic Management of Patients Prescribed Peripartum Anticoagulants
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Introduction/Purpose: Anticoagulants are frequently prescribed to pregnant patients to minimize potential complications associated with a venous thromboembolism. The American College of Gynecologists and Obstetricians recommends that a protocol regarding anticoagulant medication holding time prior to neuraxial anesthesia be available on each labor and delivery unit; however, the local anesthesia group did not have a protocol available at its clinical site prior to this project. This quality improvement project was designed to improve the care of patients taking anticoagulants during labor and delivery by creating a clinical guideline (CG) for anesthesia and anticoagulant management. Methods: A new CG based on the 2018 Society for Obstetric Anesthesia and Perinatology Consensus Statement was implemented by a private anesthesia group on the labor and delivery unit of a large community hospital. Anesthesia staff members attended a 30-minute educational presentation about the new CG two weeks prior to its implementation. Thirty-days post-implementation, anesthesia staff were emailed a link to complete an anonymous AGREE-REX (Appraisal of Guidelines Research and Evaluation – Recommendations EXcellence) tool. The AGREE-REX tool was developed to measure the clinical credibility (quality) and implementability (ease of use) of CGs. Data collection occurred over 30 days. Results: The results of the AGREE-REX survey demonstrated that anesthesia providers found the new CG both clinically credible and easy to implement on the labor and delivery unit. All the calculated scaled scores were above the 60% threshold. In addition, 100% of participants concluded the survey by recommending that this CG be used on the labor and delivery unit and other appropriate contexts. Discussion: The new CG ensured that evidence-based practice standards were met and that the care of this patient population followed a clear plan in terms of medication holding times and recommended laboratory testing. Any possible confusion about the plan of care was eliminated. After this quality improvement project, the new CG will become the standardized care plan on the labor and delivery unit enhancing patient safety, and both staff and patient satisfaction.