Defense Date

7-20-2026

Graduation Date

Summer 8-21-2026

Submission Type

Dissertation/Thesis

Degree Name

Doctor of Nurse Anesthesia Practice

Department

Doctor of Nurse Anesthesia Practice (DNAP) Program

School

School of Nursing

Faculty Mentor

Rebecca Vrescak

Keywords

obstetric anesthesia, labor epidural, epidural assessment, general anesthesia conversion, cesarean delivery, electronic medical record, quality improvement, patient safety

Abstract

Unplanned conversion from labor epidural analgesia to general anesthesia (GA) for cesarean delivery is associated with increased maternal and neonatal risk and may occur when inadequate epidural function is not recognized before operative delivery. This Doctor of Nursing Anesthesia Practice quality improvement project evaluated implementation of the Epic Epidural Assessment Event, a structured electronic medical record documentation tool designed to standardize epidural assessment during labor at a high-acuity obstetric referral center in Western Pennsylvania. Using a Plan-Do-Study-Act framework, the project compared pre- and post-implementation epidural-to-GA conversion trends, reviewed Epic audit data for documented tool utilization, and collected anonymous anesthesia provider feedback regarding usability, workflow integration, and perceived clinical value. During the post-implementation evaluation period, five documented Epic Epidural Assessment Events met predefined search criteria. One patient required conversion from epidural anesthesia to GA for cesarean delivery, while four did not. Because documented event volume was low and the evaluation period was brief, meaningful conclusions about the intervention’s effect on conversion rates could not be determined. Findings suggest that the Epic Epidural Assessment Event is feasible as a standardized documentation strategy, but additional provider education, leadership reinforcement, and longer-term monitoring are needed to improve routine use. Continued Epic audit review and sustained workflow integration may strengthen epidural assessment consistency and support safer obstetric anesthesia care.

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