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Background Although widely used in maternity care, the risks associated with local anaesthetic (LA) agents are commonly overlooked. The most serious avoidable risk associated with LA use is local anaesthetic systemic toxicity (LAST). Incidence in maternity settings is known to be underestimated due to under-recognition and under-reporting. LAST is a considerable problem, with potential financial and medico-legal as well as implications for patient safety. Methods A standardised, anonymised questionnaire was used to evaluate LAST awareness among staff of all disciplines. Awareness was examined across four domains: LA safe maximum doses, signs and symptoms of toxicity, immediate management, and the antidote type and location. Findings Poor LAST awareness was identified across all staff disciplines, with scope for substantial improvement with an interprofessional educational intervention. Only 17% were aware of any guidelines relating to LAST. Conclusion There is a need for greater focus on interdisciplinary education and the importance of shared responsibility in optimising patient safety. [ABSTRACT FROM AUTHOR]

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., Competing Interests: Competing interests: None declared.