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Enhancing Epidural Analgesia for Labor Through Education
Abstract Number: F-49
Abstract Type: Original Research
Background: Epidural rates for labor at our facility have historically been low compared to national benchmarks, though in line with rates for similar Hispanic populations. Epidural analgesia facilitates safer care, better pain relief, and is therapeutic for certain common problems such as pre-eclampsia. Our aim for this quality improvement project was to increase the epidural rate by 20% (relatively) over a period of 4 months on one labor unit representing half of our deliveries.
The Project: Two main interventions were planned. One was universal preoperative evaluation and consent upon admission to facilitate later epidural placement if elected. The second was a standard ten point educational script that was presented after preop but prior to consent. The script arose from typical concerns expressed by our patients. It sought to dispel common misconceptions about epidural analgesia. All stakeholders had input into the script and were educated prior to rollout. Multiple Plan-Do-Study-Act cycles were accomplished. Data was collected daily and weekly, which facilitated mid course corrections.
Results: The epidural rate increased over 20% (relatively) from pre-intervention and historic levels. 1430 patients were involved during this 4 month period. This was tied to grant resources that allowed the hospital to further its mission of delivering more and better quality care to the community.
Discussion: This quality improvement project successfully demonstrated that a small investment (involving simple education and minor process change) could have a dramatic impact. The growing nature of this often-underserved population makes this particularly relevant. The harder to quantify benefits may have been even more significant. Interdisciplinary and interprofessional teamwork and collaboration were enhanced; and this will enhance future progress. Satisfaction and safety were increased. An enhanced perspective was achieved by taking an honest look in the mirror. Often the barriers were more related to internal biases and expressed in flawed processes. The presumption going in too narrowly focused on patient misconceptions, without looking more broadly at the entire process.
Osterman, MJ, Epidural and Spinal Analgesia Sue During Labor: 27-State Reporting area, 2008, National Vital Statistics Reports, (2011) 59:5