From Postpartum Haemorrhage Guideline to Local Protocol: A Study of Protocol Quality

Mallory D Woiski, Helena C van Vugt, Anneke Dijkman, Richard P Grol, Abraham Marcus, Johanna M Middeldorp, Ben W Mol, Femke Mols, Martijn A Oudijk, Martina Porath, Hubertina J Scheepers, Rosella P Hermens, Mallory D Woiski, Helena C van Vugt, Anneke Dijkman, Richard P Grol, Abraham Marcus, Johanna M Middeldorp, Ben W Mol, Femke Mols, Martijn A Oudijk, Martina Porath, Hubertina J Scheepers, Rosella P Hermens

Abstract

Objective Postpartum hemorrhage (PPH) has a continuously rising incidence worldwide, suggesting suboptimal care. An important step in optimizing care is the translation of evidence-based guidelines into comprehensive hospital protocols. However, knowledge about the quality of these protocols is lacking. The objective of this study was to evaluate the quality of PPH-protocols on structure and content in the Netherlands. Methods We performed an observational multicenter study. Eighteen PPH-protocols from 3 University Hospitals (UH), 8 Teaching Hospitals (TH) and 7 Non-Teaching hospitals (NTH) throughout the Netherlands were acquired. The structure of the PPH-protocols was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) Instrument. The content was appraised using previously developed quality indicators, based on international guidelines and Advance-Trauma-Life-Support (ATLS)-based course instructions. Results The quality of the protocols for postpartum hemorrhage for both structure and content varied widely between different hospitals, but all of them showed room for improvement. The protocols scored mainly below average on the different items of the AGREE-II instrument (8 of the 10 items scored <4 on a 1-7 scale). Regarding the content, adoption of guideline recommendations in protocols was 46 %. In addition, a timely indication of 'when to perform' a recommendation was lacking in three-fourths of the items. Conclusion This study shows that the quality of the PPH-protocols for both structure and content in the Netherlands is suboptimal. This makes adherence to the guideline and ATLS-based course instructions difficult.

Trial registration: ClinicalTrials.gov NCT00928863.

Keywords: Clinical protocols; Guideline adherence; Health care quality access and evaluation; Postpartum hemorrhage.

Figures

Fig. 1
Fig. 1
Mean percentage of items with a time indication in the protocols

References

    1. Abrahamson KA, Fox RL, Doebbeling BN. Facilitators and barriers to clinical practice guideline use among nurses. The American Journal of Nursing. 2012;112(7):26–35. doi: 10.1097/.
    1. Agree Collaboration Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: The AGREE project. Quality & Safety in Health Care. 2003;12(1):18–23. doi: 10.1136/qhc.12.1.18.
    1. American College of Obstetricians and Gynecologists ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstetrics and Gynecology. 2006;108(4):1039–1047. doi: 10.1097/00006250-200610000-00046.
    1. Bailit JL, Grobman WA, McGee P, et al. Does the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes? American Journal of Obstetrics and Gynecology. 2015;213(1):86-e1. doi: 10.1016/j.ajog.2015.01.055.
    1. Berg CJ, Harper MA, Atkinson SM, et al. Preventability of pregnancy-related deaths: Results of a state-wide review. Obstetrics and Gynecology. 2005;106(6):1228–1234. doi: 10.1097/01.AOG.0000187894.71913.e8.
    1. Bodelon C, Bernabe-Ortiz A, Schiff MA, et al. Factors associated with peripartum hysterectomy. Obstetrics and Gynecology. 2009;114(1):115–123. doi: 10.1097/AOG.0b013e3181a81cdd.
    1. Bonnet MP, Deneux-Tharaux C, Dupont C, et al. Transfusion practices in postpartum hemorrhage: A population-based study. Acta Obstetricia et Gynecologica Scandinavica. 2013;92(4):404–413. doi: 10.1111/aogs.12063.
    1. Bouvier-Colle MH, Ould El Joud D, Varnoux N, et al. Evaluation of the quality of care for severe obstetrical haemorrhage in three French regions. BJOG: An International Journal of Obstetrics and Gynaecology. 2001;108(9):898–903.
    1. Brace V, Kernaghan D, Penney G. Learning from adverse clinical outcomes: Major obstetric haemorrhage in Scotland, 2003-05. BJOG: An International Journal of Obstetrics and Gynaecology. 2007;114(11):1388–1396. doi: 10.1111/j.1471-0528.2007.01533.x.
    1. Cameron CA, Roberts CL, Bell J, et al. Getting an evidence-based post-partum haemorrhage policy into practice. The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2007;47(3):169–175. doi: 10.1111/j.1479-828X.2007.00713.x.
    1. Castejon-Cervero MA, Jimenez-Parras R, Fernandez-Arias I, et al. Evaluation of compliance with the EGS guidelines in Spain, using Achievable Benchmarks of Care (ABC(R)) methodology: the IMCA Study. European Journal of Ophthalmology. 2011;21(2):149–155. doi: 10.5301/EJO.2010.5973.
    1. Clark SL. Strategies for reducing maternal mortality. Seminars in Perinatology. 2012;36(1):42–47. doi: 10.1053/j.semperi.2011.09.009.
    1. Cristina Rossi A, Mullin P. The etiology of maternal mortality in developed countries: A systematic review of literature. Archives of Gynecology and Obstetrics. 2012;285(6):1499–1503. doi: 10.1007/s00404-012-2301-y.
    1. Cromwell D, Joffe T, Hughes R, et al. The local adaptation of national recommendations for preventing early-onset neonatal Group B Streptococcal disease in UK maternity units. Journal of Health Services Research & Policy. 2008;13(2):52–57. doi: 10.1258/jhsrp.2007.007144.
    1. Dutch Society of Obstetrics en Gynaecology (NVOG). (2006). Guideline: Haemorrhagia Post Partum.
    1. Grol R, Dalhuijsen J, Thomas S, et al. Attributes of clinical guidelines that influence use of guidelines in general practice: Observational study. BMJ. 1998;317(7162):858–861. doi: 10.1136/bmj.317.7162.858.
    1. Grol R, Grol R. Improving patient care: The implementation of change in health care. 2. Chichester, West Sussex: Wiley Blackwell; 2013.
    1. Health N.D.O. (2002). Framework for prevention, early recognition and management of postpartum haemorrhage (PPH). Circular 2002; No 2002/99
    1. Ilott I, Booth A, Rick J, et al. How do nurses, midwives and health visitors contribute to protocol-based care? A synthesis of the UK literature. International Journal of Nursing Studies. 2010;47(6):770–780. doi: 10.1016/j.ijnurstu.2009.12.023.
    1. Johanson R., Cox C., Grady K., et al. (2009) Managing obstetric emergency and trauma; The MOET Course Manual.
    1. Khan KS, Wojdyla D, Say L, et al. WHO analysis of causes of maternal death: A systematic review. Lancet. 2006;367(9516):1066–1074. doi: 10.1016/S0140-6736(06)68397-9.
    1. Knight M, Callaghan WM, Berg C, et al. Trends in postpartum hemorrhage in high resource countries: A review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy and Childbirth. 2009;9:55. doi: 10.1186/1471-2393-9-55.
    1. Lalonde A, Okong P, Bhutta SZ, et al. Prevention and treatment of postpartum hemorrhage in low-resource settings. International Journal of Gynecology & Obstetrics. 2012;117(2):108–118. doi: 10.1016/j.ijgo.2012.03.001.
    1. Leblanc JM, Kane-Gill SL, Pohlman AS, et al. Multiprofessional survey of protocol use in the intensive care unit. Journal of Critical Care. 2012;27(6):738-e9. doi: 10.1016/j.jcrc.2012.07.012.
    1. Lewis G. Saving Mothers’ Lives: the continuing benefits for maternal health from the United Kingdom (UK) Confidential Enquires into Maternal Deaths. Seminars in Perinatology. 2012;36(1):19–26. doi: 10.1053/j.semperi.2011.09.005.
    1. Manias E, Street A. Legitimation of nurses’ knowledge through policies and protocols in clinical practice. Journal of Advanced Nursing. 2000;32(6):1467–1475. doi: 10.1046/j.1365-2648.2000.01615.x.
    1. Prendiville W.J., Elbourne D., McDonald S. (2000). Active versus expectant management in the third stage of labour. Cochrane Database of Systematic Reviews. (2):CD000007
    1. RCOG (2009). Prevention and management of postpartum haemorrhage. Green top guideline, no 52.
    1. Tuncalp O, Souza JP, Gulmezoglu M. New WHO recommendations on prevention and treatment of postpartum hemorrhage. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics. 2013;123(3):254–256. doi: 10.1016/j.ijgo.2013.06.024.
    1. Woiski MD, Scheepers HC, Liefers J, et al. Guideline-based development of quality indicators for prevention and management of postpartum hemorrhage. Acta Obstetricia et Gynecologica Scandinavica. 2015;94(10):1118–1127. doi: 10.1111/aogs.12718.
    1. World Health Organization. (2009). WHO guidelines for the management of postpartum haemorrhage and retained placenta.
    1. Zwart JJ, Richters JM, Ory F, et al. Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: A nationwide population-based study of 371,000 pregnancies. BJOG: An International Journal of Obstetrics and Gynaecology. 2008;115(7):842–850. doi: 10.1111/j.1471-0528.2008.01713.x.

Source: PubMed

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