Type of Resources
Klunder, Laraine. Programmed intermittent epidural bolus for labor analgesia in a critical access hospital. Unpublished Doctor of Nursing Practice Scholarly Project, University of Northern Colorado, 2021. With over two-thirds of women in the United States receiving neuraxial analgesia or anesthesia to ease the pain of labor and delivery, advances in epidural technology can potentially influence the childbirth experience. Continuous epidural infusion (CEI) with patient-controlled epidural analgesia (PCEA) has been the mainstay for delivering epidural labor analgesia for the past two decades; however, programmed intermittent epidural bolus (PIEB) is making its debut as a promising new technology to improve labor analgesia. Literature suggests delivery of programmed boluses of dilute local anesthetic with or without opioid at regularly spaced intervals may result in lower local anesthetic utilization while maintaining or improving analgesia quality and maternal satisfaction and minimizing motor blockade. The purpose of this Doctor of Nursing Practice (DNP) scholarly project was to develop and plan for translation of an evidence-based clinical practice protocol for PIEB for labor analgesia in a critical access hospital. The clinical practice protocol incorporated findings from an integrated literature review. Planning for implementation of the clinical practice protocol consisted of a before-and-after without control design to measure the effect of PIEB with PCEA modality for labor analgesia (after group) on analgesia quality, local anesthetic utilization, and prevalence of motor blockade compared to the CEI with PCEA modality (before group). The plan for translation includes the provision of staff education about protocol implementation. Lastly, structure, process, outcomes, and balancing measures were identified to evaluate translation of the practice change. Statistical analysis using SAS software was used where applicable.