Implementation of Perioperative Anesthesia Considerations for Military Veterans Who Consume Cannabis: A Quality Improvement Project

Purpose

As no widely accepted recommendations or guidelines on perioperative management for the cannabis-consuming patient exist, this quality improvement project aimed to identify and implement evidence-based recommendations for cannabis-consuming patients throughout the perioperative period. The objectives of this project were (1) to improve anesthesia providers’ knowledge on how to care for cannabis-consuming patients, (2) to increase anesthesia providers’ self-efficacy in caring for cannabis-consuming patients, and (3) to assess the frequency of utilization of the given evidence-based recommendation.

Design

This quality improvement project incorporated a pretest-posttest design.

Methods

Nurse anesthetists, resident nurse anesthetists, and nurse practitioners (staff) in an urban veteran’s hospital participated in the project. Following the Johns Hopkins Evidence-based Practice Model, a literature review was conducted via PubMed, Cochrane Library, and Cumulative Index to Nursing & Allied Health Literature to determine anesthetic considerations for cannabis consumers. Evidence was synthesized and translated into a live educational seminar that was evaluated via an electronic questionnaire before and after (pretest-postest) the seminar. Frequency of education utilization was measured via sticker poster system. Normality tests were conducted using Jamovi computer software. Wilcoxon signed-rank tests were pursued due to the skewed data distribution.

Findings

Results from 22 articles informed content for the live educational seminar; 26 staff participated in the pretest-posttest. Specific preoperative, intraoperative, and postoperative considerations were extracted from the evidence. Questionnaire results showed a 60% increase in self-efficacy (P = .001), a 44% increase in knowledge (P = .001), and a 92% utilization rate (26/28 cannabis-consuming patients) of the recommendations in the clinical setting.

Conclusions

With nearly 20% of veterans indicating use of cannabis, perianesthesia nurses should be aware of the unique preoperative, intraoperative, and postoperative considerations for the cannabis-consuming patient.