Date of Award

Summer 2016

Document Type

Dissertation

Degree Name

Doctor of Nursing Practice (DNP)

Department

Mennonite College of Nursing

First Advisor

Denise Wilson, PhD, APN, FNP, CDE

Abstract

Purpose: The purpose of this project is to evaluate a practice change of implementing peri-operative amiodarone infusion for cardiac surgical patients at a large northern Illinois hospital to reduce the incidence of post-operative atrial fibrillation. Evidence supports use of prophylactic amiodarone as a strategy to reduce its incidence. The sequelae of untreated post-op atrial fibrillation include increased risk of embolic stroke, extended hospitalization, and increased healthcare costs.

Data Sources: The Society of Thoracic Surgeons (STS) Adult Cardiac Surgical Database is a validated research tool used to collect comprehensive data on its member surgeons. A pre/post intervention case-controlled retrospective study design was used and the hospital’s STS data was analyzed. Cardiac surgery patients from January 1 – June 30, 2015 who did not receive amiodarone and those from July 1 – December 31, 2015 who did were compared.

Conclusions: Post-op atrial fibrillation rates after cardiac surgery improved with the intervention, but were not statistically significant. Total incidence decreased from 17.9% to 8.3%. Isolated coronary artery bypass grafting patient incidence decreased from 15.4% to 5.4%, aortic valve surgery incidence decreased from 31.3% to 30.0%, and combination CABG and valve surgery decreased from 25% to 0%.

Implications for practice: Amiodarone is an effective way to reduce rates of post-op atrial fibrillation. When coupled with a beta-blocker regimen, further improvement is evident, although not statistically significant. Baseline rates below national average likely diminished the significance of this study; however, any effort to ameliorate post-op atrial fibrillation and the subsequent complications of its incidence should be taken.

DOI

http://doi.org/10.30707/ETD2016.Russell.J

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