RT Journal Article
SR Electronic
T1 Fetal health surveillance: a community-wide approach versus a tailored intervention for the implementation of clinical practice guidelines
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 469
OP 474
VO 167
IS 5
A1 Barbara Davies
A1 Ellen Hodnett
A1 Mary Hannah
A1 Linda O'Brien-Pallas
A1 Dorothy Pringle
A1 George Wells
A1 members of the Perinatal Partnership Program of Eastern and Southeastern Ontario
A1 the Society of Obstetricians and Gynaecologists of Canada
YR 2002
UL http://www.cmaj.ca/content/167/5/469.abstract
AB Background: The decreased use of electronic fetal monitoring (EFM) for healthy women in labour and the increased provision of professional support to all women in labour is recommended by experts. We evaluated the effectiveness of a community-wide approach to transferring research results to practice using a regional committee, newsletter articles and annual conference presentations compared with an additional tailored hospital intervention involving workshops to enhance self-efficacy for nurses, policy review, multidisciplinary meetings, rounds and unit discussions. Methods: We compared the proportion of women at low risk who received EFM and the proportion of nurses' time spent providing labour support before and after the intervention within each of 4 hospitals (2 tertiary and 2 secondary). One hospital of either type was randomly selected to receive the tailored intervention. Randomly selected charts (n = 200) were reviewed for the use of EFM at each hospital before (1995) and after (1996) the intervention. Trained observers at randomly selected times recorded the nurses' activities, including time spent providing labour support before and after the intervention. Results: >At the intervention secondary hospital, there was a large decrease in the use of EFM, from 90.1% before to 41.0% after the intervention (p < 0.001), but no change in nurses' time spent providing labour support. At the intervention tertiary hospital there was no change in EFM rates, but there was a small, statistically significant increase in time spent providing labour support (23.5% to 29.8%, p < 0.001). A negative effect on time spent providing labour support was found at the control secondary hospital (decrease from 19.6% to 12.8%, p < 0.001), with no change in the EFM rate. At the control tertiary hospital there was a small decrease in the use of EFM, from 99.5% to 91.4% (p < 0.001), but no change in time spent providing labour support. Interpretation: The results are mixed, and the tailored intervention thus appeared to have limited effects. No association was found between the reduction in the use of EFM and an increase in nurses' time spent providing labour support.