RECOMMENDATION FOR CERTIFIED REGISTERED NURSE ANESTHETISTS TO PERFORM PERIPHERAL NERVE BLOCKS

Currently at one Southern California medical center, of the over 2500 annual surgical cases where a peripheral nerve block (PNB) might be appropriate, less than 50 PNBs were done. Patients with ultrasound-guided PNBs report increased satisfaction secondary to better pain relief, fewer systemic complications, and faster recoveries as compared to other anesthetic techniques. Only anesthesiologists administer regional anesthesia at this facility; additional patients could benefit from PNBs due to the safety of this anesthesia type and its post-surgical potential for improved pain management. Adopting a credentialing process for CRNAs to provide PNBs will improve access to this type of anesthesia. Current literature and best practice evidence for CRNA administration of regional anesthesia were reviewed for this Doctor of Nursing Practice project and a policy for a credentialing/privileging process was developed. The literature indicated that graduates of accredited schools of anesthesia who successfully pass the National Certification Examination are qualified, entry-level practitioners capable of administering regional anesthesia. Ultrasound reduces the learning curves of novice providers, significantly improves provider proficiency, and could be used in a credentialing/privileging process. To improve patient access to PNBs, recommendations for implementing and evaluating a CRNA privileging process for PNB administration include: (a) establishing a pilot program to re-educate CRNAs in PNB administration supervised by regional anesthesia experts, (b) adopting standardized procedure guidelines outlining required competencies prior to privileging, and (c) evaluating the pilot program iv by reviewing provider competence, assessing patient satisfaction at 24-hour postsurgical follow-up, and reassessing if sufficient PNB cases exist to maintain privileged provider competency.