Background and Aims Our anaesthetic department provides labour epidural as part of a secondary care maternity service. Recently there has been concern that our rate of accidental dural punctures (ADPs) has increased so we undertook a service evaluation of labour epidurals. We compared our data to the standards set out in ‘Raising the Standards: RCoA Quality Improvement Compendium’.
Methods Prospective data collection over a 3 month period. Reviewed the anaesthetic logbook and patient notes to gather: time, grade anaesthetist, epidural technique, incidence of re-siting, incidence of ADP and subsequent management.
Results Standards were met in the following domains block success 93% (target >85%), resites 7% (target <15%), satisfaction at follow-up 98% (target
>98%). However, our ADP rate was above range at 3.2% (target < 1%). Despite a range of loss of resistance (LOR) techniques used, this did not impact ADP. Evenings appeared to be the safest time of day, but otherwise even spread over 24 hours. Possibly higher ADP rates from experienced anaesthetists who were returning to the labour ward after a break.
Conclusions Our ADP rate was unacceptable, without a clear explanation. Possibly causes include a change of equipment (we only had combined spinal-epidural sets the year before), a busier labour ward, and turnover of anaesthetic staff newly restarting epidurals. It could be anomalous due to a short data collection window. We gained a model epidural back which is always available for practice and have started collecting data again to see if our unit has improved.
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