Education of Stakeholders and Guideline Proposal for Nitrous Oxide Use as Labor Analgesia at an Army Hospital

POSTER

Education of Stakeholders and Guideline Proposal for Nitrous Oxide Use as Labor Analgesia at an Army Hospital Noelle Dove, RNC-MNN, DNP Student University of Utah College of Nursing PURPOSE To assess attitudes, barriers and readiness for nitrous oxide (N2O) use as labor analgesia to stakeholders at an Army hospital as a step in offering N2O at all Army hospitals. OBJECTIVES •Compose and submit a guideline to an Army Hospital institution for N2O use in labor. •Increase knowledge of N2O use in labor among stakeholders through an educational presentation and proposed guideline. •Improve the guideline by revising it based on feedback from participants. •Disseminate the N2O guideline to the Army CNMs and other stakeholders. • • • • • • • BACKGROUND Most laboring women in the United States do not have access to N2O in labor. In 2009, the American College of NurseMidwives issued a position statement that endorsed including N2O for laboring women. N2O is a safe and effective option for pain control in labor. N2O does not affect labor progress or fetal heart rate. Most women in the U.S. use epidural anesthesia when they may prefer N2O Women desire more choices for labor pain. N2O is a safe, evidence-based option that should be available at birthing institutions. METHODS • Review of research on N2O, other institutional guidelines and format of guidelines from other military hospitals to determine the content needed to implement N2O. • Presentation of an evidence-based guideline on N2O to an Army hospital. • Evaluation of the guideline with presentation, discussion, and participant evaluation. • Revise the guideline based on feedback. • Disseminate the revised presentation and guideline to Army CNMs. RESULTS • Guideline and educational presentation created and given to stakeholders 51 on March 20, 2017. • Feedback obtained from 46 participants. Pre and post test score comparison • 89% of participants desired more information on the pretest. • Overall knowledge increase of 24%. • Most misperceptions related to onset and offset of N2O. • 80% of participants desired to offer N2O before presentation, 93% after. • Participants most concerned over environmental exposure to staff due to poor ventilation or machine leaks. • Other concerns identified are cost, hospital administration, and security as barriers to implementation. • • • • • • CONCLUSION/IMPLICATIONS Incorporating N2O requires buy-in from all members of the healthcare team. Most members of the healthcare team have misperceptions and want knowledge of N2O use in labor. This guideline and presentation helped stakeholders at this Army hospital increase knowledge and desire for N2O. N2O should be offered to all laboring women, including those birthing in Army hospitals. Nurses can lead the way in offering this safe and effective form of pain control. Adoption of N2O is facilitated by a guideline, education of stakeholders, institutional assessment, planning, and teamwork with stakeholders.