Background:
One in 300 opioid naïve women become addicted to opiates after cesarean birth. After cesarean, women are often prescribed more opiates at discharge than necessary, resulting in increased opportunity for diversion.
Purpose:
To improve use of comfort strategies and nonopioid medications to decrease the amount of opioids required postoperatively and prescribed at discharge, in women who gave birth via cesarean.
Methods:
An interdisciplinary workgroup was convened to assess data on opioid use, prescribing practices at discharge, and nurses' use of alternative comfort strategies from January to March 2018. A comfort bundle was designed to include standardized use of preoperative acetaminophen, postoperative comfort education, simethicone, postoperative gum chewing, and abdominal binders. Nurses and healthcare providers were educated on the initiative. Data were reevaluated and compared with preintervention data assessing for improvement and adherence to the bundle components.
Results:
There was a 61% reduction in morphine milliequivalents given to women after cesarean birth between the first quarter in 2018 and the fourth quarter in 2018. Comparing March with December, 2018 data, adherence to each bundle component improved. The percentage of women receiving less than 20 tabs of oxycodone at discharge increased from 26.3% to 96.7%.
Implications for Nursing Practice:
Nurses should evaluate comfort options provided after cesarean birth and educate women about use of nonopioid pain relief strategies. A standardized process to address pain and comfort after cesarean birth may decrease exposure to opioids while maintaining comfort.
Preeclampsia is a serious health condition and leading cause of perinatal and neonatal morbidity and mortality. Research supports the use of low-dose aspirin therapy to prevent preeclampsia in high-risk pregnant people. This quality improvement project outlines the implementation of a preeclampsia risk screen in the electronic health record to ensure standardized screening for, and provision of, low-dose aspirin therapy consistent with professional guidelines. Two thousand three hundred seventy-one patients were seen between March and November 2020 at 13 OB/GYN and family practice offices at a large health system in our state. Provider screening and prescribing rates were evaluated at the first prenatal visit, and at 3-month intervals using an analytics dashboard built in the EHR. In the first 3 months after rollout visits at all offices in our system (March to May 2020), the average screening rate during first prenatal visits at all offices was 74.2% (n 5 561), 41% (n 5 230) had a positive screen, and 81.3% (n 5 187) of those who screened high risk were prescribed aspirin as recommended. At 9 months after rollout, the screening rate during first prenatal visits at all offices improved to 95.6% (n 5 782), 39.6% (n 5 310) of those screened, screened positive, and 97.1% (n 5 301) were prescribed lowdose aspirin therapy appropriately.
This study aimed to assess the effect of lavender aromatherapy on anxiety and comfort after cesarean birth. Study Design: Randomized control trial. Methods: Forty-eight patients who had a cesarean birth were asked to complete the six-item State and Trait Anxiety (STAI-6) score to assess their level of anxiety pre-and postapplication of either lavender aromatherapy or placebo during their inpatient postpartum stay. Their comfort and pain levels pre-and postadministration were assessed, and differences between groups were analyzed. Results: There was no difference in postintervention STAI-6 scores between the aromatherapy and place-bo groups (p = .56). Women who received the lavender aromatab ® had signifi cantly (p = .037) higher self-reported levels of comfort (M 2.6 SD .82) when compared with those who received placebo (M 2.0 SD 1.0). Clinical Implications: Many women use aromatherapy at home to promote comfort and relaxation. Women feel lavender aromatherapy improves their comfort in the hospital setting after cesarean birth. Clinicians should consider ways to safely use aromatherapy as one option to promote postoperative cesarean birth care.
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