Improving the Effective Use of End-Tidal Carbon Dioxide Monitoring Postoperatively Through Nursing Education

Abstract

Background: Postoperative patients in the Post Anesthesia Care Unit (PACU) are recovering from procedures where they may receive anesthesia, sedatives, and analgesics that place them at a high risk for respiratory depression and associated complications including ICU admissions, brain damage, and even death. To prevent these complications, postoperative patients are closely monitored but there are limitations in current monitoring techniques’ ability to detect respiratory depression. Capnography, or End Tidal Carbon Dioxide (ETCO₂) monitoring is the measurement of the partial pressure of Carbon Dioxide (CO₂) at the end of an exhaled breath. ETCO₂ monitoring is a continuous way to accurately measure respiratory rate and CO₂ levels to provide safe monitoring of ventilatory status in extubated postoperative patients. Objective: The purpose of this project was to provide evidenced-based education to the PACU nursing staff at Northwest Medical Center on ETCO₂ monitoring in order to increase nursing knowledge, confidence, and ability to utilize ETCO₂ monitoring effectively in the postoperative setting. Design: This was a quality improvement project that utilized a pre-test/post-test design to measure the benefit of an evidenced-based education program for PACU nursing staff on ETCO₂ monitoring. Setting: This project was implemented in the PACU at Northwest Medical Center in Tucson, AZ. Participants: The participants of this project were Registered Nurses (RN) who work in PACU either full time or part time, with a total of 20 nurses that fit this criterion. Measurements: Data collection for this project was done through pre-test and post-tests, both with the same 20 questions, 15 of which were multiple choice questions based on content and 5 of which were a Likert scale evaluating nursing confidence and likelihood of changing future practice. A paired T-test was used on content questions and Wilcoxon Signed Rank Test on Likert scale questions to determine statistical significance of the difference scores before and after receiving education about End Tidal CO₂ monitoring. Results: Eighteen RNs attended the educational presentation and completed pre-and post-tests. The mean score and standard deviation on the pre-education tests was 6.67 ± 2.4 while post-test mean score was 14.28 ± 0.75, with a paired t test showing significant improvement between scores (p < 0.0001). The Likert scale questions evaluating nursing confidence and likelihood to initiate ETCO₂ monitoring in the next month all showed a significant improvement in scores (p<0.05, Wilcoxon Signed Rank Test). Conclusion: In this quality improvement project, we demonstrate that an ETCO₂ education session provided to nurses improved knowledge and intention to implement knowledge in the PACU at Northwest Medical Center (Tucson, AZ). This project met its goal of providing evidenced-based education on ETCO₂ monitoring in order to increase nursing knowledge, confidence, and ability to utilize ETCO₂ monitoring effectively.