Using clinical governance to standardise an epidural service

Area of Science:

• Anesthesiology
• Pain Management
• Health Services Research

Background:

• Continual epidural infusions are a standard method for managing postoperative pain.
• A national audit revealed significant variations in epidural infusion concentrations and delivery systems among pain specialists.
• These variations were also observed in local clinical practice, highlighting a need for standardization.

Purpose of the Study:

• To standardize the provision and management of continual epidural infusions within Southampton University Hospitals NHS Trust.
• To address local disparities in epidural infusion practices.
• To improve the consistency and quality of postoperative pain management.

Main Methods:

• Collaboration between the acute pain service and the pharmacy department.
• Benchmarking against national practices through an unpublished audit.
• Efforts to achieve anaesthetist consensus on a standardized, commercially available solution.
• Securing funding for a dedicated delivery system.

Main Results:

• Identified significant variations in prescribed concentrations and delivery systems nationally and locally.
• Initiated a standardization process involving multidisciplinary collaboration.
• Faced challenges in achieving anaesthetist consensus and securing funding for equipment.

Conclusions:

• Standardization of epidural infusions is complex, requiring consensus and resources.
• Addressing practice variations is crucial for optimizing postoperative pain management.
• Multidisciplinary efforts are essential for successful implementation of standardized pain services.