Semester

Summer

Date of Graduation

2026

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Anesthesiology

Committee Chair

Pavithra R. Ellison

Committee Member

Mike Frame

Committee Member

Candy Mahle

Committee Member

Kristen Nelson

Committee Member

Billie Vance

Abstract

Introduction: The use of multiple sedatives, anxiolytics, and analgesics to prevent emergence agitation (EA)in pediatric patients undergoing myringotomy (MT) placement at West Virginia University Medicine Children's is leading to prolonged lengths of stay in the post-anesthesia care unit (PACU). These extended stays are causing delays in subsequent procedures and raising concerns for staff, patients, and their families.

Evidence Review: The combination of intranasal dexmedetomidine given preoperatively and intramuscular ketorolac given intraoperatively for pediatric patients reduces the incidence of EA more effectively than oral midazolam and acetaminophen.

Purpose: This evidence-based practice project aims to establish a standardized, evidence-based anesthesia plan to enhance the management of pre-anesthesia medication administered before MT surgery. The primary goal is to reduce the incidence of EA, ultimately promoting faster recovery and earlier discharge for pediatric patients.

Methods: The Iowa Model was used to guide the development, implementation, and evaluation of an evidence-based change project.

Results: Thirteen pediatric patients were included across all three pilot rounds. Although Phase 1 recovery time briefly improved during the first round, overall PACU LOS increased slightly compared to baseline (40.85 versus 38.85 minutes). Protocol adherence declined in later rounds due to workflow and scheduling barriers. The pilot did not significantly reduce EA or PACU times across the pilot period

Discussion: Early benefits were seen when the protocol was followed, but policy and workflow barriers prevented consistent implementation. System constraints limited success and indicated the need for redesign before future use.

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