Improving the consent process for labour epidurals; A Quality Improvement Project

Introduction

Provision of clear, concise information to patients undergoing procedures is critical. This is a particular challenge for people in labour. They are often distressed and in significant pain when requesting an epidural. It is therefore important that they are provided with easily digestible information to reinforce verbal discussions. We aimed to improve patient information on epidurals at West Suffolk Hospital including the creation of tools to complement verbal discussions in the antenatal and peripartum periods.

Methods

We used qualitative surveys of a range of staff and patients to guide the development of new, clear information for those wanting information about epidurals and their risks in labour. An initial survey was written and distributed in April 2022 to the midwives, obstetricians and anaesthetists to gather opinions on the existing text based epidural patient information leaflet. An updated illustrated epidural card (Fig. 1) taken from the Obstetric Anaesthetist’s Association (OAA) was introduced in May 2022 (1).

A follow-up survey was distributed in June 2022, to the same staff groups. We subsequently produced a  succinct patient information video using AdobeTM Aminate was produced. The video follows the procedure of inserting an epidural, a discussion on risks and finally signposting to sources of further information in less than 6 minutes. It was designed to be watched both antenatally and whilst on labour ward via the mobile computers in each delivery room. Figure 1 demonstrates images from the current version of the video.

A third survey was written to evaluate the video in February 2023. The video has subsequently been presented at obstetric departmental meetings and at the patient engagement meetings.

Results

In the initial survey 94% of midwives and 75% of doctors thought the existing leaflet could be improved with an average rating of 3.4/5. Importantly 88.3% of women required assistance to read the card. This may reflect a suboptimal presentation of information for those that are often unable to dedicate their full attention.

Results following the introduction of the new graphical card are shown in fig. 3. 87.5% of responders felt the leaflet was an improvement in comparison to the original version with an improved rating of 4.75/5.

In the survey assessing the animated video has received good initial feedback from anaesthetists with 100% of responders agreeing the video would be a useful aid. An interesting suggestion of a concise 1-2 minute version for those in labour is currently in development.

The full video has been positively received at the multidisciplinary obstetric meeting and is currently being  reviewed by our ‘patient voices’ group and trust communication department.

 Conclusion

High quality patient information prior to an epidural is crucial, we have introduced an updated leaflet and designed a succinct animated video, which has received exceptionally positive feedback. We feel that the ability to provide the same verified, easy to digest information is invaluable in improving the birth experience of those requesting epidurals.

References

1.Obstetric Anaesthetists’ Association. Risks of Regional Anaesthesia (epidurals & spinals) and General Anaesthesia Explained. Available at: https://www.oaa-anaes.ac.uk/assets/_managed/cms/files/ACCEA%202014/Labour%20pain%20infographic_July%202019.pdf