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Background and Aims At our institution, the responsibility for administration of local anaesthetic doses via peripheral nerve catheters is shared between pain specialist nurses and the on-call anaesthetist. However, due to factors such as workload it is not possible to administer every dose. We aimed to quantify the proportion of doses administered, and to identify deficiencies to guide interventions to improve this.

Methods Over a 6-month period starting November 2023, data were collected regarding the catheters inserted, prescriptions, number of doses administered and missed, duration in-situ and documentation regarding missed doses. The number of potential doses was calculated based on the frequency of the prescription, and the duration left in-situ.

Results 67 peripheral nerve catheters were inserted; 47 rectus sheath, 17 serratus anterior/erector spinae plane and 3 fascia iliaca. The median duration in-situ was 4 days (local hospital guidelines 3-5 days). Only 432 (47%) doses were administered out of 903 potential doses. Factors leading to missed doses included workload, handover omission and missing prescriptions.

Conclusions Peripheral nerve catheters are currently not being optimally utilised for analgesia, whilst patients are being exposed to the risk of insertion complications. In the short term, we will implement multiple interventions with the aim of increasing the proportion of doses administered, such as improving handover and prompting prescriptions after insertion. Another solution being explored is using dedicated programmed intermittent bolus pumps, but these come with both training and financial implications. Local governance recognised the risk as described by our audit, and a process of procuring these pumps has been commenced.