Improving Local Anesthetic Systemic Toxicity (LAST) Recognition and Treatment Through Education of Advanced Practice Providers on a Code Stroke Team

BACKGROUND: Local anesthetic systemic toxicity (LAST) presents with neurological and cardiovascular symptoms. LAST typically occurs immediately after administering a local anesthetic, but can occur a few days later. Symptoms can resemble a stroke.

LOCAL PROBLEM: In a large academic medical center in the United States, some code strokes called on post-surgical patients result negative for ischemia or hemorrhage, but documentation is unclear if patients were assessed for LAST. This project aims to educate code stroke team advanced practice providers to identify LAST and include LAST as a differential diagnosis.

METHODS: The Model of Improvement is the framework for this quality improvement project. Interventions focused on provider education and were assessed using a pre/post-education questionnaire through PDSA cycles. Results were used to inform a recommendation for practice change.

INTERVENTIONS: The project team implemented a live online educational session and posted a LAST flyer in the code stroke team office. A pre/post questionnaire assessed knowledge and comfort identifying LAST in advanced practice providers on a code stroke team. A recommendation was made to add a box within the code stroke checklist to prompt providers to assess for LAST.

RESULTS: Educational interventions increased provider comfort and confidence in identifying LAST. These results supported the recommendation to revise the code stroke checklist to prompt providers to assess for LAST as a differential diagnosis in code stroke patients. The code stroke team accepted the recommendation for practice change and implemented the revised checklist.

CONCLUSIONS: Despite limited participation from the code stroke team, providers’ comfort and confidence in identifying LAST increased after the educational interventions. The revised code stroke checklist is intended to prompt providers to assess for LAST as a differential diagnosis in code stroke patients. Recommended next steps include further studies on compliance and effectiveness of the revised code stroke checklist.