Article Text
Abstract
Introduction The UK Department of Health have targeted a reduction in stillbirth by 50% by 2025; to achieve this, the first version of the Saving Babies’ Lives Care Bundle (SBLCB) was developed by NHS England in 2016 to improve four key areas of antenatal and intrapartum care. Clinical practice guidelines are a key means by which quality improvement initiatives are disseminated to front-line staff.
Methods Seventy-five clinical practice guidelines covering the four areas of antenatal and intrapartum care in the first version of SBLCB were obtained from 19 maternity providers. The content and quality of guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Maternity health professionals in participating organisations were invited to participate in an anonymous survey to determine perceptions toward and experiences of the use of clinical practice guidelines using a series of Likert scales.
Results Unit guidelines showed considerable variation in quality with median scores of 50%–58%. Only 4 (5.6%) guidelines were recommended for use in clinical practice without modifications, 54 (75.0%) were recommended for use subject to modifications and 12 (16.7%) were not recommended for use. The lowest scoring domains were ‘rigour of development’, ‘stakeholder involvement’ and ‘applicability’. A significant minority of unit guidelines omitted recommendations from national guidelines. The majority of staff believed that clinical practice guidelines standardised and improved the quality of care but over 30% had insufficient time to use them and 24% stated they were unable to implement recommendations.
Conclusion To successfully implement initiatives such as the SBLCB change is needed to local clinical practice guidelines to reduce variation in quality and to ensure they are consistent with national recommendations . In addition, to improve clinical practice, adequate time and resources need to be in place to deliver and evaluate care recommended in the SBLCB.
- obstetrics and gynaecology
- clinical practice guidelines
- healthcare quality improvement
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Footnotes
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Contributors KW, SAR and AEPH designed the SPiRE evaluation and obtained funding. YZL, SK, GLS, SR and AEPH reviewed the clinical guidelines. KW, SAR and AEPH conducted the data analysis. The manuscript was prepared by YZL, KW and AEPH and edited by all authors.
Funding The SPiRE project was funded by NHS England. AEPH is Director of the Maternal and Fetal Health Research Centre funded by Tommy’s.
Disclaimer The funders had no role in the collection, data analysis, writing of or decision to present this manuscript.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement There is no ethical approval in place to share data from participating Trusts. Anonymised data from staff and patient questionnaires can be made available subject to appropriate confidentiality agreements between participating organisations. Investigators wishing to obtain data should contact the corresponding author AH.