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A multi-centre quality improvement project to reduce the incidence of obstetric anal sphincter injury (OASI): study protocol.

Bidwell, P; Thakar, R; Sevdalis, N; Silverton, L; Novis, V; Hellyer, A; Kelsey, M; van der Meulen, J; Gurol-Urganci, I (2018) A multi-centre quality improvement project to reduce the incidence of obstetric anal sphincter injury (OASI): study protocol. BMC Pregnancy Childbirth, 18 (1). p. 331. ISSN 1471-2393 https://doi.org/10.1186/s12884-018-1965-0
SGUL Authors: Thakar, Ranee

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Abstract

BACKGROUND: Third and fourth degree perineal tears, or obstetric anal sphincter injuries (OASI), sustained during childbirth can result in anal incontinence and psychosocial problems which require ongoing treatment. Within the English National Health System (NHS) reported rates of OASI have gradually increased. In response, a care bundle was developed incorporating four elements: 1) antenatal information to women, 2) manual perineal protection during all vaginal births, 3) episiotomy to be performed with a 60° mediolateral angle at crowning (when clinically indicated) and 4) perineal examination (including per rectum) after childbirth. Implementation of the OASI Care Bundle is aided by a skills development module and an awareness campaign. The project is a collaboration between two national professional bodies, an NHS hospital trust and an academic institution. METHODS: Implementation of the OASI Care Bundle will be evaluated using a stepped-wedge design. From January 2017 sixteen maternity units across England, Wales and Scotland will participate in the study over a 15-month period, with sequential roll-out of the intervention in four blocks (regions) of four units. The primary clinical outcome is OASI rate. Regression analysis will adjust for differences in organisational characteristics and obstetric risk factors in women who gave birth before and after implementation of the care bundle. Focus group discussions and in-depth interviews with clinicians will evaluate the feasibility of integrating the care bundle into routine practice. Interviews with women will explore the acceptability of the intervention. DISCUSSION: This protocol outlines the evaluation of our quality improvement project which aims to prevent OASI using a bundle of evidence-based interventions that are each widely used in practice. The OASI project aims to 1) standardise practice to prevent OASI in a way that is acceptable to clinicians and women and 2) identify the barriers and enablers associated with upscaling interventions within maternity units. If found to be effective, feasible and acceptable, the OASI Care Bundle will be shared with a range of audiences using the communication channels available to the professional bodies. TRIAL REGISTRATION: The OASI Project was retrospectively registered on the ISCTRN12143325 database date assigned 03/10/2017.

Item Type: Article
Additional Information: © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Care bundle, Childbirth, Fourth degree tears, OASI, Obstetric anal sphincter injury, Perineal trauma, Quality improvement, Third degree tears, Anal Canal, Delivery, Obstetric, England, Episiotomy, Fecal Incontinence, Female, Humans, Implementation Science, Incidence, Lacerations, Obstetric Labor Complications, Patient Care Bundles, Patient Education as Topic, Perineum, Physical Examination, Pregnancy, Prenatal Care, Quality Improvement, Scotland, Wales, Perineum, Humans, Fecal Incontinence, Lacerations, Physical Examination, Prenatal Care, Delivery, Obstetric, Episiotomy, Incidence, Pregnancy, England, Scotland, Wales, Anal Canal, Female, Obstetric Labor Complications, Patient Education as Topic, Quality Improvement, Patient Care Bundles, Implementation Science, Obstetric anal sphincter injury, OASI, Third degree tears, Fourth degree tears, Perineal trauma, Quality improvement, Care bundle, Childbirth, Obstetrics & Reproductive Medicine, 1114 Paediatrics and Reproductive Medicine, 1117 Public Health and Health Services, 1110 Nursing
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: BMC Pregnancy Childbirth
ISSN: 1471-2393
Language: eng
Dates:
DateEvent
13 August 2018Published
3 August 2018Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
7674Health FoundationUNSPECIFIED
PubMed ID: 30103734
Web of Science ID: WOS:000441843000004
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/112515
Publisher's version: https://doi.org/10.1186/s12884-018-1965-0

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