Implementation of a Verification of Local Anesthetics (VoLS) Tool to Reduce Local Anesthetic Systemic Toxicity

Background: Local anesthetic systemic toxicity (LAST) is a life-threatening condition resulting from the overdose of local anesthetics (LA). Untreated LAST can lead to seizures, cardiopulmonary collapse, and possible death.

Local Problem: Our project was conducted at a level-one trauma center in the Southeast. The population encompassed patients who received regional anesthetics for pain management in the pre-operative setting. The suspected occurrences of LAST doubled the frequency reported in current literature. This project aimed to improve communication between providers regarding the tracking and documentation of local anesthetics.

Methods: The Evidence-based Practice Improvement (EBPI) model was the framework to guide this project. Literature supported using a standardized communication tool to improve provider handoff and documentation accuracy. The project group created a chart sticker to document LA doses throughout the peri-operative period. Change was measured through the percentage of stickers placed on the patient's charts and the completion of the sticker.

Interventions: The pain management team placed the VoLS sticker in the patient's chart for patients receiving pre-procedural regional anesthetics. Multiple anesthesia providers filled out the sticker during the peri-operative period.

Results: During the 12-week implementation phase of the project, 255 patients received blocks. Sixty-seven percent of the charts identified received the VoLs sticker, meeting our compliance aim of 25%. Completeness of documentation, at 5.3%, fell short of our second aim. The average compliance preoperative documentation was 67.3%. Intraoperative compliance of local anesthetic documentation at time out was 4.5%.

Conclusions: Our project group successfully created a means to track local anesthetic dosing throughout the perioperative period, reflected in the achievement of our aim of greater than 25% sticker placement on the patient's chart. Suggestions for enhancing LA dosing communication could include the incorporation of a documentation prompt for "LA at timeout" in the electronic health record.

Keywords: local anesthetics, local anesthetic systemic toxicity, communication tool, perioperative, compliance