Article type
Year
Abstract
Background: Clinical practice guidelines aim to improve the quality and consistency of care. In 2001 the National Institute of Clinical Excellence published an evidence based clinical guideline on the use of electronic fetal monitoring (EFM) during intrapartum care1. A range of factors can influence the adherence to clinical guidelines including the compatibility of recommendations with values of healthcare professionals. Recommendations that require minimal change are more likely to be complied with. Other factors such as implementation strategies also have an impact- for example passive dissemination maybe less effect than the use of reminders or educational outreach visits2. Objectives: To evaluate the impact of the EFM guideline on reported change in clinical practice in England and Wales.
Methods: Two postal surveys of all delivery suite midwifery managers in England and Wales. The 1st survey was conducted in 1999 during development of the clinical guideline before the guideline was published3. The follow up survey was conducted in 2004, three years after guideline publication. The surveys included questions on the use of admission CTGs, indications for the use of continuous EFM during labour, and the use of Fetal blood sampling. Non responders were sent a further survey and received a telephone reminder. All questionnaires were anonymised.
Results: The response to the first survey was 100%, the response to the second survey was 81% (214). In the first survey few maternity units reported using EFM in unselected patients - this had not changed in the follow-up survey. Admission testing was used in almost all units in 1999, 11%(n=17) had stopped using admission testing in all women, but 70% (n=146) now reported they used admission testing in selective women in accordance with the guidelines. The units that had access to FBS facilities had increased in 1999 compared to earlier surveys the proportion with this facility had not changed markedly in 2004.
Conclusions: Recommendations within the EFM guideline that accorded with clinical practice or accepted clinical practice were likely to be implemented. The recommendation about not using admission CTGs represented a marked change in practice and did not accord with beliefs at the time of publication. The guideline was passively disseminated nationally and with one national educational meeting. Local initiatives have varied this could also have influenced uptake. Self reported practice is likely to over-estimate the impact of guidelines compared to measuring actual practice.
References: 1. Royal College of Obstetricians and Gynaecologists. The Use of Electronic Fetal Monitoring: The use and interpretation of cardiotocography in intrapartum fetal monitoring. No 8. 2001. London, RCOG press. Evidence based Cinical Guidelines 2. From best evidence to best practice: effective implementation of change in patients care. R. Grol, J Grimshaw. Lancet. Oct 2003;362(9391):1225-30. 3. Maternal and Child Health Research Consortium. Confidential Enquiry into Stillbirths and Deaths in Infancy:eighth annual report. 8. 2001. London, Maternal and Child Health Research Consortium.
Methods: Two postal surveys of all delivery suite midwifery managers in England and Wales. The 1st survey was conducted in 1999 during development of the clinical guideline before the guideline was published3. The follow up survey was conducted in 2004, three years after guideline publication. The surveys included questions on the use of admission CTGs, indications for the use of continuous EFM during labour, and the use of Fetal blood sampling. Non responders were sent a further survey and received a telephone reminder. All questionnaires were anonymised.
Results: The response to the first survey was 100%, the response to the second survey was 81% (214). In the first survey few maternity units reported using EFM in unselected patients - this had not changed in the follow-up survey. Admission testing was used in almost all units in 1999, 11%(n=17) had stopped using admission testing in all women, but 70% (n=146) now reported they used admission testing in selective women in accordance with the guidelines. The units that had access to FBS facilities had increased in 1999 compared to earlier surveys the proportion with this facility had not changed markedly in 2004.
Conclusions: Recommendations within the EFM guideline that accorded with clinical practice or accepted clinical practice were likely to be implemented. The recommendation about not using admission CTGs represented a marked change in practice and did not accord with beliefs at the time of publication. The guideline was passively disseminated nationally and with one national educational meeting. Local initiatives have varied this could also have influenced uptake. Self reported practice is likely to over-estimate the impact of guidelines compared to measuring actual practice.
References: 1. Royal College of Obstetricians and Gynaecologists. The Use of Electronic Fetal Monitoring: The use and interpretation of cardiotocography in intrapartum fetal monitoring. No 8. 2001. London, RCOG press. Evidence based Cinical Guidelines 2. From best evidence to best practice: effective implementation of change in patients care. R. Grol, J Grimshaw. Lancet. Oct 2003;362(9391):1225-30. 3. Maternal and Child Health Research Consortium. Confidential Enquiry into Stillbirths and Deaths in Infancy:eighth annual report. 8. 2001. London, Maternal and Child Health Research Consortium.