Abstract
BackgroundMaternity care is recognised as a particularly high-risk speciality that is subject to investigation and inquiry, and improvements in risk management have been recommended. However, the quality of guidelines for local reviews of maternity incidents is unknown. The aim of the study is to appraise the quality of local guidance on conducting reviews of severe maternity incidents in the National Health Service.MethodsGuidelines for incident reviews were requested from all 211 consultant-led maternity units in the UK during 2012. The Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) was used to evaluate the quality of guidelines. The methods used for reviewing an incident, the people involved in the review and the methods for disseminating the outcomes of the reviews were also examined.ResultsGuidelines covering 148 (70%) of all NHS maternity units in the UK were received for evaluation. Most guidelines (55%) received were of good or high quality. The median score on ‘scope and purpose’ (86%), concerned with the aims and target population of the guideline, was higher than for other domains. Median scores were: ‘stakeholder involvement’ (representation of users’ views) 56%, ‘rigour of development’ (process used to develop guideline) 34%, ‘clarity of presentation’ 78%, ‘applicability’ (organisational and cost implications of applying guideline) 56% and ‘editorial independence’ 0%. Most guidelines (81%) recommended a range of health professionals review serious maternity incidents using root cause analysis. Findings were most often disseminated at meetings, in reports and in newsletters. Many guidelines (69%) stated lessons learnt from incidents would be audited.ConclusionsOverall, local guidance for the review of maternity incidents was mostly of good or high quality. Stakeholder participation in guideline development could be widened, and editorial independence more clearly stated. It was unclear in over a quarter of guidelines whether changes in practice in response to review recommendations were audited or monitored; such auditing should be mandatory. Further research is required to examine the translation of guidance into practice by evaluating the quality of local reviews of maternity incidents.
Highlights
Maternity care is recognised as a high-risk speciality that is subject to investigation and inquiry, and improvements in risk management have been recommended
For every maternity unit in England we noted the level achieved in the Clinical Negligence Scheme for Trusts (CNST) [13], which is only applicable in England, and compared the levels for those units that participated in the study and those that did not
120 guidelines applicable to 148 maternity units were included in the appraisal
Summary
Maternity care is recognised as a high-risk speciality that is subject to investigation and inquiry, and improvements in risk management have been recommended. The aim of the study is to appraise the quality of local guidance on conducting reviews of severe maternity incidents in the National Health Service. Learning from clinical incidents is a recognised part of ongoing quality improvement in health care [1-3]. Many factors affect quality of care including the organisation of services, leadership, monitoring systems, adequate infrastructure, the resources available, both human and material, and continual improvement. Maternity care is recognised as a high-risk speciality that is subject to investigation and inquiry, and improvements in risk management have been recommended [4-6]. The National Reporting and Learning System [7], currently administered by the Care Quality Commission and formerly by
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