P.79 A care bundle to improve perioperative care of women having caesarean section under general anaesthesia using appreciative methodology

Introduction: Two failed intubations at our Trust highlighted the need to examine current practice for obstetric general anaesthesia. The aim of this medical student project was to examine the entire care pathway of women undergoing a general anaesthetic for caesarean section (CS) and introduce interventions to improve care. The first element included optimising rates of first-time intubation;the second involved optimisation of post-op analgesia;the third investigated follow-up for women who had difficult/failed intubations perinatally. Methods: A blended methodology was used: traditional ’PDSA’ quality improvement methods were employed with appreciative inquiry (AI). AI is an approach to organisational improvement that focuses on strengths and assets, rather than the traditional approach of focussing only on adverse incidents or failures. On account of COVID, planned face-to- face interviews and direct observation of practice could not proceed. Questions where therefore emailed to all staff. Questions were appreciative and thus focussed the responder on situations where care had gone well, as well as identifying areas for improvement. Stakeholders were actively encouraged to be creative and submit their ideas for improvement as part of the co-development of the service. Results: Regarding improving rates of successful intubation, 23 anaesthetists and ODP’s responded. The most important factors in successful intubation were thought to be: systematic approach, patient positioning;equipment preparation and a calm environment. Interestingly, ’leadership’ and ’procedural skill’ were mentioned least frequently. Suggestions for enhancing safety included clearly communicated plans for difficult/failed intubations. Sixty-five percent of respondents requested further teaching on obstetric difficult airway management;with suggestions such as 30 second simulation drills, revision of OAA/DAS and changing attitudes towards obstetric anaesthesia so that trainees are less fearful. The post-operative questionnaire gained 31 responses. The current post-CS advice and leaflet was felt to be inadequate (58%). The need for improved advice on pain management and activity was highlighted. Common practice following difficult intubation included face-to-face discussions with the patient and logging on the Difficult Airway Society database. Some wrote to the GP. Discussion: Based on the findings, a number of action plans have been implemented: 1) Regular 30 second MDT simulated intubation drills 2) new easy-read, obstetric intubation prompt (to be used in conjunction with OAA/DAS flowchart) to be visible in maternity theatres 3) Generation of rapid pre- intubation checklist 4) Publication of a new leaflet to address pain control and activity post LSCS, to include helpful quotes from past patients. 5) Production of a checklist to ensure standardisation of process for women who have had difficult/failed intubation.