A follow-up study of the extended labour epidural analgesia service at a regional hospital in Gauteng

Abstract

Background: In 2014 an audit was performed at Rahima Moosa Mother and Child Hospital (RMMCH) on the daytime labour epidural analgesia service, prior to extension of the service to 24 hours. Since implementation of the extended service, no follow-up audit has been performed. Services based on pain management require regular auditing in order to determine safety, efficiency, and practices in keeping with current evidence. Methods: A retrospective audit using consecutive convenience sampling was done reviewing all epidural records at RMMCH from 1 June 2017 to 31 May 2018. Results: During the study period 658 labour epidurals were inserted for a total of 12 600 deliveries, from which 637 (96.8%) records were recovered. The labour epidural rate was 5.2%, a statistically significant improvement from 1.6% (p<0.0001) in 2014. The major complication rate was 0.4% with one respiratory arrest and one cardiac arrest. The most common minor complication was multiple attempts (15.1%). Odds ratios for caesarean section and assisted deliveries in this study were 0.8422 and 0.5020 respectively. The majority of epidurals were maintained by continuous infusion (52.8%). Patient satisfaction was 97.2%. Documentation improved significantly from 2014 to our study (p<0.001)