EPA 4A.1: Deliver Local Anesthesia

SCOPE OF WORK: This activity includes effectively administering topical and local anesthetic injections and nerve blocks.

Domains of Competence

Person-Centered Care
Critical Thinking and Decision Making
Biomedical Science Application

Knowledge

Basic molecular mechanisms of topical and local anesthesia
Types of topical and local anesthetics available in the U.S.
Choice/indications/contraindications of local anesthetics based on biomedical principles and patient medical history
Necessary vital signs to monitor pre- and post-operatively
Dose calculations
Anatomical landmarks for local anesthesia
Injection technique
Proper positioning and alternate considerations when giving local anesthesia
Strategies to ensure patient comfort
Understand local anesthesia related complications and their management
Required documentation of local anesthesia in electronic patient record (EPIC Wisdom)

Skills

Select appropriate local anesthetic informed by an understanding of disease processes
Dose appropriately based on patient weight, medical and medication history, and estimated procedure time
Monitor patient vitals pre- and post-operatively
Deliver local anesthesia in a person-centered manner while assuring patient comfort and achieving necessary anesthetic effect
Deliver anesthesia using proper technique and patient position
Properly document components of local anesthetic in electronic patient record (Epic Wisdom)

Deliver Local Anesthesia	Meets Expectations of the Graduate	Progressing	Below Expectations	Critical Error

MONITORING VITAL SIGNS AND COMFORT	Correctly obtains vital signs pre-op and post-op and identifies any signs that need to be addressed; confirms patient is numb before proceeding; monitors patient’s comfort throughout procedure	Obtains vital signs pre-op and post-op but may not use appropriate size cuff or position it correctly, unsure whether to proceed and requires guidance, monitors patient comfort	Obtains vital signs pre-op but is unaware that they used wrong size cuff or positioned it incorrectly; may proceed when inappropriate; may not take post-op vital signs; may not monitor patient’s comfort	Fails to obtain vital signs pre-op and/or post-op; proceeds with local anesthesia when it may be unsafe and may result in harm to the patient
PATIENT POSITION	Properly positions patient (supine unless clinically contraindicated)			Treats healthy patient sitting up during injection
TOPICAL ANESTHETIC	Applies appropriate topical anesthetic, at correct site, with the correct technique¹ (dry tissue with gauze before applying topical); waits > 1 minute after application before injection	Chooses appropriate anesthetic, but may ask for guidance to locate the correct site; waits at least one minute	Knows to apply a topical anesthetic but unsure what to do; does not wait at least one minute after application before injection	Fails to apply topical anesthetic resulting in patient experiencing pain during the procedure
ANESTHETIC SELECTION AND DOSE	Selects appropriate anesthetic type and dosage	Selects appropriate anesthetic type but inappropriate dosage	Selects inappropriate anesthetic type or dosage	Administers an anesthetic or dosage (e.g., 4% solution for nerve block) that may lead to patient harm
INJECTION TECHNIQUE	Locates correct injection site, uses correct technique, including stable finger rest, slow injection rate (about 1cc per minute), and capping	Did not perform one of the technique components (site, finger rest, technique, capping) needs guidance to perform correctly	Did not perform two of the technique components (finger rest, site, technique, capping), avoidable delays in patient care	Uses incorrect technique (no finger rest; injection rate too fast, capping) that may lead to patient injury or inability to numb patient that leads to aborting procedure; proceeds without permission
Adequate Anesthesia	Patient felt no pain during surgery	Patient felt some pain but was able to tolerate surgery	Learner doesn’t understand the anatomical structures involved during local anesthetic blocks and infiltrations. Learner uses materials and techniques that could injure nerves	Anesthesia inadequate to accomplish planned procedure

¹ Dry tissue with gauze before applying topical.

Referral Medication Prescription