A quality improvement project to improve neuromonitoring for labour epidurals and following caesarean sections under neuraxial blocks
•Serious neurological complications following obstetric regional anaesthesia are rare.
•A joint guideline [1] recommends neurological monitoring with an hourly straight leg raise (SLR) during labour with an epidural for early identification of neurological complications (Figure 1).
•A further recommendation states that SLR at 4 hours, following a spinal anaesthetic or epidural top-up, should be used to screen for recovery from motor block.
•Both NICE [2] and this guideline recommend hourly sensory monitoring during labour with an epidural, which had not been occurring at our trust.
•We report the following findings after introducing several interventions to meet these standards.
Currently in its 5th cycle, snapshot audits were conducted before and after each intervention.
A publicity and education drive was instituted including posters and monthly midwifery teaching.
An hourly SLR check was introduced onto the combined intrapartum Modified Early Warning Score (MEWS) & partogram monitoring chart (Figure 3).
A patient wristband was introduced giving the time a patient should be able to SLR following neuraxial blockade [3]. (Figure 2).
Sensory block height assessment added to MEWS and partogram charts. SLR wristband added to maternity handover checklist (Figure 4).
•80% (n=18) of patients that received an epidural during labour had hourly SLR documented on their partogram.
•65% (n=17) received a SLR wristband post-operatively. Of these patients, 89% were aware that they should be able to SLR at 4 hours.
•82% (n=11) midwife respondents had received teaching on sensory block height assessments in those with labour epidurals.
•100% (n=11) of the midwife respondents felt that the prompt on the MEWS chart was helpful in ensuring these motor and sensory assessments took place.
•80% (n=18) of patients that received an epidural during labour had hourly SLR documented on their partogram.
•65% (n=17) received a SLR wristband post-operatively. Of these patients, 89% were aware that they should be able to SLR at 4 hours.
•82% (n=11) midwife respondents had received teaching on sensory block height assessments in those with labour epidurals.
•100% (n=11) of the midwife respondents felt that the prompt on the MEWS chart was helpful in ensuring these motor and sensory assessments took place.
•The SLR wristband will be added as a prompt on the postoperative checklist.
•A QR code on the wristband will link to a web page with information regarding neurological complications in different languages.
