Quality Improvement Proposal

 

Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice.

Include the following:

Provide an overview of the problem and the setting in which the problem or issue occurs.
Explain why a quality improvement initiative is needed in this area and the expected outcome.
Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.
Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.

Sample Solution

Kara F et al[11] who compared the effects of epidural 0.5% bupivacaine and 0.5% levobupivacaine administration on anaesthesia quality, incidence of side effects in hip and lower extremity surgery and Cox CR et al[12] who compared 0.5% bupivacaine and 0.5 % levobupivacaine administered epidurally for lower limb surgeries found no significant difference in the onset of sensory and motor blockade, which may be due to the same concentration (0.5%) of local anaesthetic used in our study also.

The duration of motor block was assessed by onset of motor block to complete recovery (Bromage scale-0). In our study there was no significant difference in duration of motor block in both the groups(p>0.05). Similar to our study a study done by Casimiro C et al[8] who compared levobupivacaine plus fentanyl and racemic bupivacaine plus fentanyl in epidural anaesthesia for lower limb surgeries and in another study by Kara F et al[11] compared the effects of epidural 0.5% bupivacaine and 0.5% levobupivacaine administration on epidural anaesthesia found that there was no significant difference in duration of motor blockade with both drugs (p>0.05) and Kopacz et al[13] who compared epidural 0.75% levobupivacaine with racemic bupivacaine for lower abdominal surgeries found similar duration of motor block in both groups (p>0.05).

However in contrast to our study Garcia et al[14] compared 0.5% levobupivacaine with 0.5% bupivacaine in epidural anaesthesia for caesarean delivery ,found a longer duration of motor block with levobupivacaine. The doses used in our study were same as that used in study by Garcia et al but have longer duration of motor block with levobupivacaine have no clinical significance and could not be explained as far as the dose is concerned.

In our study mean duration of sensory block was comparable in both groups (p value >0.05). The results of our study are similar to the study done by Casimiro C et al[8] who concluded that Levobupivacaine plus fentanyl versus racemic bupivacaine plus fentanyl in epidural anaesthesia for lower limb surgeries produced sensory blockade of similar duration. And also in a study done by Kara F et al[11] who compared the effects of epidural 0.5% bupivacaine and 0.5% levobupivacaine in hip and lower extremity surgery found no significant difference in duration of sensory blockade with both drugs.

In contrast Cox CR et al[12] compared levobupivac

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