Title: An audit cycle on written information for labour epidurals: are we offering it?

Background and Goal of Study: Written information about epidural analgesia given during labour improves knowledge1. The Royal College of Anaesthetists suggest that 95% of women should be offered written information during labour2.
Our goal was to assess how often women are offered this written information, implement changes aimed at improvement and then re-audit our practice.

Material and methods: We conducted a prospective audit on thirty consecutive women attending the Labour Ward in Barnet Hospital in May 2015. Responses to two questions were recorded: Were you offered written information about labour epidurals during labour? Would this have been/was this useful?
Our initial audit showed that written information was not routinely being offered.
Laminated copies of the Obstetric Anaesthetists' Association Epidural Information card were placed in every Labour Ward suite. Further copies, including versions in the five most common foreign languages in our area, were made readily available. We also delivered an educational presentation to the department.
Using the same methodology, we re-audited our practice in November 2015.

Results and discussion: Our initial audit showed 3.3% of women were offered written information. 46.7% stated that they would have found it useful. Closing the loop, 70% of women were offered written information and 76% found it useful. Of those not offered written information, 50% said they would have found it useful. In both groups, pain was the most common reason for thinking the information would not be or was not useful (75% and 80% respectively).

Conclusions: Women were not routinely being offered written information about labour epidurals and many would have found it useful. After implementing changes, we greatly increased the number of women being offered written information. We showed that once women are offered the information cards, they find it more useful than we expected from the initial audit. Pain is the most common reason for limiting the usefulness of written information. We are looking at ways to improve consent by providing more information during the antenatal period.

References: 
1) White LA, Gorton P, Wee MY et al. Written information about epidural analgesia for women in labour: did it improve knowledge? Int. J. Obstet. Anesth. 2003; 12(2):93-7 
2) Colvin JR & Peden CJ. Raising the Standard: a compendium of audit recipes. Royal College of Anaesthetists. 2012. 3rd Edition. 208-9