South West Anaesthesia Research Matrix

The next SWARM backed project will be looking at the antenatal provision of written information on options for analgesia and anaesthesia during labour and delivery in the South West. This project, led by Dr. Lizzie Freeman, won at the SWARM Hive of Ideas in October 2022. 

Background

Women are frequently required to make rapid decisions during labour, often when in pain, fatigued, anxious and having received opiate analgesia or Entonox. All can contribute to difficult communication and comprehension of new information. Anaesthetists must gain informed consent prior to carrying out neuraxial procedures (epidurals, spinals and CSEs), which can be challenging for both patient and clinician if the information provided is unfamiliar.

Joint guidance from the OAA and AAGBI from 2013 states that ‘Up-to-date, locally relevant information about the services offered should be available for mothers in a range of formats appropriate to their needs’, usually antenatally [1]. This is also reflected in the RCoA GPAS guidance on provision of obstetric anaesthetic services (Chapter 9) and the AAGBI guidance on consent (2017), which state that ‘every unit should provide, in early pregnancy, advice about pain relief and anaesthesia during labour and delivery. An anaesthetist should be involved in preparing this information and should approve the final version’[2][3].

What is the aim of the project? 

We aim to:

• Assess the current provision of antenatal information on analgesic and anaesthetic options for labour and delivery in the South West peninsula region.
• Evaluate maternal attitudes towards antenatal information on analgesia/anaesthesia and its impact on expectations, maternal experience and satisfaction.
• Using Public and Patient Involvement (PPI) and in collaboration with the Devon Maternity Voices Partnership, develop new resources in line with AAGBI/OAA guidance.

What is the plan for the project?

• May 2023: We will be conducting a trainee led survey of postnatal women at Derriford Hospital. Data will be collected over a 24 hour period, during which time all postnatal women meeting inclusion criteria will be identified and offered the survey to complete. We will interrogate this data to ensure validity of the study protocol before we proceed with the region wide survey.
• June/July 2023: The region wide survey will be carried out using the finalised protocol. 
• July 2023 onwards: Data will be analysed using quantitative methods, comparing the provision of information to national guidelines. A patient focus group (recruited via the Devon Maternity Voices Partnership) will assist with our analysis of the survey results in order to draw conclusions and inform the development of new resources.
• These resources will be introduced at Derriford and shared with other sites, subject to necessary approvals.
• We will aim to repeat the survey at any sites adopting the new resource. The Newcastle PROMs text follow-up system can be used at Derriford to measure change over time.

For more information or if you would like to get involved, please contact your local lead or the project lead Dr. Lizzie Freeman at Lizzie.freeman@nhs.net

Local leads

Derriford – Tak Chan

Torbay - Rebecca Allott

Exeter - Laura Markham

Taunton - Timothy Richards

Truro – Sarah Cassie

Barnstaple - Edward Cope

References

1.     Obstetric Anaesthetists’ Association & Association of Anaesthetists of Great Britain and Ireland.  OAA/AAGBI Guidelines for obstetric anaesthetic services 2013. Accessed at https://www.aagbi.org/sites/default/files/obstetric_anaesthetic_services_2013.pdf

2.     Royal College of Anaesthetists, 2022. Chapter 9: Guidelines for the Provision of Anaesthesia Services for an Obstetric Population. Accessed at https://rcoa.ac.uk/gpas/chapter-9

3.     Association of Anaesthetists. AAGBI: Consent for anaesthesia 2017. Anaesthesia 2017; 72: 93–105