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Systematic Capture of Regional Anesthesia Quality Metrics for Labor Analgesia
Abstract Number: S-49
Abstract Type: Original Research
Background: Neuraxial anesthesia and analgesia is used frequently in obstetrics(1) with varying rates of complications across institutions(2,3). Previous large scale studies have investigated adverse events including dural puncture, venous puncture, paresthesias, and epidural failure and replacement rates(2). However, in order to compare rates of complications and adverse outcomes to national norms the data must be complete and accurate. We initiated a quality improvement (QI) project that compared our current medical record system with an automated electronic medical record (EMR) system to evaluate core regional anesthesia quality measures.
Methods: Medical records were reviewed for completeness and documentation of quality measures including inadvertent dural puncture, aspiration of blood into the epidural catheter, paresthesia during epidural placement, epidural failure requiring replacement or use of a second anesthetic, failure to document bilateral sensory level at least once and patient satisfaction. Data was collected for 10 days before and 10 days after the EMR was changed to mandate completion of all six quality measures before the case could be signed and closed.
Results: Records for 79 patients were reviewed; 36 patients pre-interventions and 43 patients post-intervention. Pre-intervention, gaps in documentation for the quality measures were significant, with missing or unknown responses as follows: parasthesias 14%, blood in catheter 8%, dural puncture 11%, epidural replacement 97%, bilateral sensory levels 31%, and patient satisfaction 64%. The rate decreased to zero for all six quality measures once the mandatory EMR system was instituted. Rates of adverse outcomes could not be compared because data collected before the mandatory reporting change was incomplete.
Discussion: This QI intervention eliminated documentation deficiencies. Adapting the EMR has allowed us to track quality markers related to neuraxial anesthesia. As a result of this study, we are notified of each patient who is dissatisfied with her epidural and investigate each failure prior to discharge. Limitations include using some quality measures that may or may not be important for optimal patient care.
1. Osterman M, Martin J. National Vital Statistics Reports Epidural and Spinal Anesthesia Use During Labor : 27-state Reporting Area , 2008.; 2011:1–14.
2. Paech MJ, Godkin R, Webster S. Complications of obstetric epidural analgesia and anaesthesia: a prospective analysis of 10,995 cases. Int. J. Obstet. Anesth. 1998;7(1):5–11. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15321239.
3. Hollister N, Todd C, Ball S, Thorp-Jones D, Coghill J. Minimising the risk of accidental dural puncture with epidural analgesia for labour: a retrospective review of risk factors. Int. J. Obstet. Anesth. 2012;21(3):236–41. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22633623. Accessed December 10, 2013.