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Improving local anaesthetic systemic toxicity (LAST) awareness in maternity care using tailored educational tools
  1. Amy E Edwards1,
  2. Gemma M Bowsher1,
  3. Sahil Deepak1,
  4. Mohamed Ali2
  1. 1GKT School of Medical Education, Faculty of Life Sciences & Medicine, King’s College London, London, UK
  2. 2Department of Anaesthetics, Kent & Canterbury Hospital, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
  1. Correspondence to Amy E Edwards; amy.a.edwards{at}


Local anaesthetic (LA) agents are widely used in maternity care. Although relatively safe, their use does carry risks, the most serious of which is systemic toxicity (LAST). LAST poses a major threat to maternal and neonatal safety due to the frequency of LA administration in maternity care and the under-recognition of toxicity in such settings, which has been reported globally. Our aim was to prevent LAST occurrence in a District General Hospital (DGH) maternity unit by improving staff awareness through the implementation of a tailored educational programme. We used a standardised 14-point questionnaire to evaluate LAST awareness among staff of all disciplines. Domains of interest were LA maximum safe doses, LAST recognition, immediate management and use of antidote. Following baseline assessment, we implemented an educational programme in three stages. Each featured a distinct tool: video presentation, poster and lanyard card. Awareness was reassessed between stages using the same questionnaire. We identified poor baseline awareness across all non-anaesthetic disciplines. Average questionnaire score improved from 3.9/14 (n=23) to 8.1/14 (n=30) during the project period, an increase of 109.3%. Scores improved in all professional groups and a change in workplace culture has been reported. Using a tailored interprofessional educational intervention, we generated an increase in awareness and maintained this over a 4-month period. Improved knowledge and a shift in clinical attitudes towards shared responsibility will reduce avoidable peripartum risk associated with LAST at this DGH. Although the tools used were specific to LAST in this setting, they could be easily adapted for NHS maternity services elsewhere and indeed other areas of care.

  • anaesthesia
  • women’s health
  • healthcare quality improvement
  • patient safety

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  • Contributors AEE, GMB and SD contributed equally to project design and implementation, under the supervision of MA. All authors contributed to the manuscript. AEE reviewed and submitted the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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