Introduction: Conversion of labour epidural analgesia to surgical anaesthesia is common practice(1). Clinically, the time from decision to delivery is often pressurised and uncertainty of drug preparations can be an obstacle to doing so safely(1). Our aim was to make this process more efficient and safer, reducing stress in anaesthetic teams. 

Methods: We timed our colleagues making up the medication for an epidural top up and whether this was performed in keeping with local guidelines. Our intervention was making up an epidural top up kit including drugs, equipment and written instructions with maximum safe local anesthetic doses. We then timed colleagues using the kit and asked if they found the process safer.

Results:

Participants ranged from CT2 to ST7 and all currently in an obstetric rotation.

1st phase recorded times ranging from from 2 minutes 04 seconds to 3 minutes and 14 seconds with mean time of 2 minutes 32 seconds.

2nd phase with kit the range from 1 minute 56 seconds to 2 mins 42 with mean time 2 minutes 17 seconds.

100% agreed using the kit was safer

Before the kit only 73% of syringes were labelled and 10% did not match policy. After introducing the kit, 100% of the syringes were labelled correctly and all made in accordance to guidelines.

Discussion: 

Aim: Minimise stress and uncertainty in a pressurisedenvironment to improve patient safety and reduce the time to delivery.

Apprehend: Trainees attending labour ward may have completed their obstetric rotation elsewhere by having the kit available it reduces human error and supports the trainee in a new environment and we hope to include them in our next cycle(2).

Appreciate: Need to embed kit maintenance in daily practice. We provided teaching to department and include it in induction.

Aspire: Compare the time to prepare GA drugs to see if it affects time to delivery.