Date of Award

Fall 12-7-2018

Degree Type

Doctoral Nursing Capstone Project

Degree Name

Doctor of Nursing Practice (DNP)

School

Leadership and Advanced Nursing Practice

Committee Chair

Dr. Mary Jane Collins

Committee Chair Department

Nursing

Committee Member 2

Dr. Marjorie Geisz-Everson

Committee Member 2 Department

Nursing

Committee Member 3

Dr. Janie Butts

Committee Member 3 Department

Nursing

Abstract

A clinical affiliate hospital in Mississippi lacked a best practice clinical policy regarding the most appropriate skin preparation solution to use prior to neuraxial anesthesia. The evidence showed that alcoholic chlorhexidine is the optimal solution due to advanced characteristics which help reduce infection. Reducing infections can potentially reduce further complications for the patient, hospitalization length, and cost. Also, chlorhexidine was found safe to use for neuraxial anesthesia if cross-contamination is avoided and adequate drying time is allowed. Lastly, alcoholic povidone-iodine is an appropriate alternate if 0.5% chlorhexidine is unavailable.

A best practice clinical policy was formulated and presented to a panel of experts, which included a certified registered nurse anesthetist, anesthesiologist, health policy expert, and infection preventionist due to their advanced knowledge and daily involvement with the current topic. Data was gathered via an evaluation tool which assessed the panels’ input on whether the findings were useful, were of high quality, and would have an impact on the facility.

The majority of the panel strongly agreed that the information presented was useful, was of high quality, would pose an impact on the facility, and that the policy should be adopted. The general concern among the panel of experts was that 0.5% chlorhexidine is not readily available in individual applicators. Chlorhexidine with a 2% concentration is readily available, but this concentration is not recommended for lumbar puncture due to a higher risk of neurotoxicity. Therefore, 0.5% chlorhexidine in 70% alcohol should be chosen for skin preparation prior to neuraxial anesthesia as a result of strong supporting evidence.

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