Abstract
BackgroundDespite the introduction of evidence based guidelines and practical courses, the incidence of postpartum hemorrhage shows an increasing trend in developed countries. Substandard care is often found, which implies an inadequate implementation in high resource countries. We aimed to reduce the gap between evidence-based guidelines and clinical application, by developing a strategy, tailored to current barriers for implementation.MethodsThe development of the implementation strategy consisted of three phases, supervised by a multidisciplinary expert panel. In the first phase a framework of the strategy was created, based on barriers to optimal adherence identified among professionals and patients together with evidence on effectiveness of strategies found in literature. In the second phase, the tools within the framework were developed, leading to a first draft. In the third phase the strategy was evaluated among professionals and patients. The professionals were asked to give written feedback on tool contents, clinical usability and inconsistencies with current evidence care. Patients evaluated the tools on content and usability. Based on the feedback of both professionals and patients the tools were adjusted.ResultsWe developed a tailored strategy to improve guideline adherence, covering the trajectory of the third trimester of pregnancy till the end of the delivery. The strategy, directed at professionals, comprehending three stop moments includes a risk assessment checklist, care bundle and time-out procedure. As patient empowerment tools, a patient passport and a website with patient information was developed. The evaluation among the expert panel showed all professionals to be satisfied with the content and usability and no discrepancies or inconsistencies with current evidence was found. Patients’ evaluation revealed that the information they received through the tools was incomplete. The tools were adjusted accordingly to the missing information.ConclusionA usable, tailored strategy to implement PPH guidelines and practical courses was developed. The next step is the evaluation of the strategy in a feasibility trial.Trial registrationClinical trial registration: The Fluxim study, registration number: NCT00928863.
Highlights
Despite the introduction of evidence based guidelines and practical courses, the incidence of postpartum hemorrhage shows an increasing trend in developed countries
In this paper we describe the development of an implementation strategy for a high resource obstetric setting to improve guideline adherence regarding postpartum hemorrhage
In the three steps described above we have created a strategy to improve the adherence to evidence based guidelines and the Advanced trauma life support (ATLS)-based course for prevention and treatment of Postpartum hemorrhage (PPH)
Summary
Despite the introduction of evidence based guidelines and practical courses, the incidence of postpartum hemorrhage shows an increasing trend in developed countries. Substandard care is often found, which implies an inadequate implementation in high resource countries. The incidence of PPH is estimated around 10,5% and in high resource countries an increasing trend in PPH incidence has been seen [2]. Substandard health care is often suggested as a possible cause for inadequate reduction of morbidity [5,6,7]. It seems that evidence-based guidelines are not optimally adhered to, leading to substandard care and a gap between evidence-based medicine and clinical application [8]
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