Article
Poor translation of the nation-wide postpartum hemorrhage guideline and MOET-instructions into local protocols (the Fluxim study)
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Published: | July 10, 2012 |
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Outline
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Objective: Post-Partum Hemorrhage (PPH) continuous having a rising incidence in developed countries. The aim of this study was to evaluate the degree of implementation of the Dutch PPH-guideline and the Managing Obstetric Emergency Trauma (MOET)-instructions into local hospital protocols, next to the protocol-structure.
Methods: 18 local PPH-protocols (3 university (UH), 7 teaching (TH) and 8 non-teaching (NT)) were derived throughout The Netherlands. From 37 valid guideline-based indicators, 82 items were used to determine the degree of implementation. The presence of an item and the corresponding time-indication was measured. The AGREE-instrument was used to assess the structure of the protocols.
Results: Overall implementation of the indicators was 46%, with a highest score of 68% (UH) and a lowest of 18% (NT). Indicators with their corresponding time-indications were mentioned in 23% of the protocols. Even the key-recommendation for all deliveries, which is; active management of labor, was present in only 33% of the protocols. Less than 50% of the protocols had a structure according to the AGREE-instrument.
Discussion and implication GL-developers/users: This study shows that in The Netherlands, the first step in implementation of the national PPH-guideline and MOET-instructions is not optimal. Care is presumed to follow the content of the local protocol, containing a clear structure. Therefore, we expect poor adherence to the guideline/course-instructions. Proper implementation is essential for good adherence in care, so measurement of the actual care will be the next step in the improvement strategy of PPH-care