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Neuraxial and Narcotic Anakgesia for Labor; Effects of Administrative Mandates on Availability and Use in a Serbian Obstetric Hospital
Abstract Number: T-55
Abstract Type: Original Research
Introduction: In Serbia, the use of analgesia for labor has been low. In 2012 the Department of Anesthesia at Clinical Center Vojvodina (CCV), requested a multi-year Kybele Inc. collaboration to train physicians in the use of neuraxial analgesia for (NAL). During the first visit in 2012, the Kybele team members demonstrated the use of IV narcotic analgesia for labor (IVNA) as an alternative if NAL could not be performed. In the fall of 2015, the Health Ministry of Serbia mandated nationwide NAL availability at no patient cost. In August 2016, the CCV administration mandated an evening attending plus anesthesia resident shift for labor analgesia. We report 5 year results in use of NAL and IVNA and the effects of administrative changes on use.
Method: Since 2012, Kybele has conducted annual week long visits to CCV to provide didactic and clinical training, and collaborative process change. In 2016, Kybele conducted 2 visits. Training in the use of IVNA was not performed after the initial visit in 9/2012. In the fall of 2015, the Serbian Health Ministry and in August 2016, the CCV hospital leadership both mandated the process changes cited above. Chi square analysis with adjustments for multiple comparisons were used to compare year over year changes in NAL, IVNA use, 2012 - 2016.
Results Table 1: Yearly NAL use increased 330% from 2012- 2016) (year over year comparisons). Similar percentage increases in IVNA occurred. Overall, analgesia use increased 6 fold 2012 - 2016. During, 1-7/2016, NAL use decreased substantially compared to 2015 coinciding with Health Ministry mandates. Both NAL and IVNA increased substantially 8-12/2016 after staffing adjustments. No serious side effects of IVNA were noted
Discussion: The use of NAL increased nearly 3 ½ times, 2012 – 2016. IVNA increased similarly despite no further training in its use after 2012, perhaps reflecting patient choice (many patients fear NAL), provider perceived ease of administration of IVNA compared to NAL, or lack of training in NAL. IVNA may offer a safe alternative to NAL in settings where NAL use is not available1, 2; safe use requires adequate maternal/fetal monitoring for adverse effects.3 The nationwide mandate for no patient cost NAL without changes in staffing lead to a decrease in NAL use. CCV staffing changes improved overall analgesia availability.
1.Isaacs RA et al. Int J Obstet Anesth. 2016;27:90-2.
2.Melber A et al. Int J Obstet Anesth. 2016;27:89-90.
3.VanDeVelde M IJOA 2016;25:66-74