Graduation Date
Summer 8-31-2025
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
Michael Neft
Committee Member
Diane Adams
Committee Member
Tracy Vogel
Keywords
quality improvement, goal directed fluid therapy (GDFT), preoperative checklist, cesarean section, obstetrics, fluid status
Abstract
Abstract
Maternal hypotension following neuraxial anesthesia during cesarean section is a common and potentially harmful complication. While vasopressors are often used for this issue, they carry risks to fetal well-being. Goal-directed fluid therapy (GDFT) provides an individualized approach that may improve outcomes by optimizing fluid status perioperatively. This quality improvement project aimed to increase provider awareness of fluid status through the implementation of a preoperative checklist that assessed fluid status in women undergoing cesarean section. A preoperative fluid assessment checklist was developed using evidence-based predictors of fluid status and integrated into anesthesia workflow. The project followed the Plan-Do-Study-Act cycle and was guided by Systems Theory. Retrospective data (n=78) and concurrent checklist data (n=20) from cesarean deliveries were collected and analyzed for crystalloid volume, vasopressor use, and spinal bupivacaine dose. A GDFT Database was established to describe the current practice related to maternal hypotension and compare that with the use of the Preoperative Fluid Status Checklist (FSC). Mean crystalloid administration increased from 1060 mL to 1300 mL after implementation. Mean phenylephrine use increased slightly (21.05 mL to 29.5 mL), while bupivacaine dose remained consistent (1.8 mL to 1.77 mL). Providers reported that the checklist was intuitive and did not disrupt workflow. Checklist implementation was feasible and well-received by anesthesia providers, supporting a standardized preoperative fluid assessment in obstetrics. Future efforts should focus on improving checklist compliance through electronic health record integration, extended implementation periods, and ongoing provider education.
Language
English
Recommended Citation
Miller, Marcus and Sorge, Michael, "Raising Provider Awareness of Fluid Status in Women Undergoing Elective Cesarean Section Through the Use of a Preoperative Checklist to Assess Fluid Status: A Quality Improvement Project" (2025). Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts. 13.
https://dsc.duq.edu/dnap/13