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P244 Development Of A Tailor-Made Implementation Strategy To Facilitate Adherence To The Dutch Postpartum Hemorrhage Guideline And Moet-Instructions
  1. S De Visser1,
  2. M Woiski1,
  3. M Hulscher2,
  4. F Vandenbussche1,
  5. L Scheepers3,
  6. R Hermens2
  1. 1Radboud University Nijmegen Medical Centre, Department of Obstetrics & Gynaecology, Nijmegen, The Netherlands
  2. 2Radboud University Nijmegen Medical Centre, Department of IQ Healthcare, Nijmegen, The Netherlands
  3. 3Maastricht University Medical Centre, Maastricht, The Netherlands

Abstract

Background Despite the introduction of a national guideline and the Managing Obstetric Emergencies and Trauma (MOET) course the incidence of postpartum haemorrhage (PPH) is increasing. We suspected inadequate guideline implementation to be underlying.

Objective Our objective was to develop and pilot test a tailor-made implementation strategy for the Dutch PPH guideline and the MOET course to increase guideline adherence.

Methods Firstly, we aggregated the results of a current care and diagnostic analysis, which yielded barriers for guideline implementation, together with evidence found in international literature. Main barriers among professionals were lack of a checklist available in the labour ward, inadequate high-risk patient identification and lack of team communication. Patients mentioned insufficient information supply. Secondly, we developed different implementation tools for professionals and patients, based on these results. These tools were evaluated in a pilot testing among both groups.

Results The strategy affects the period between the last trimester of the pregnancy till the end of the third stage of delivery. The tools for professionals consisted of a high-risk identification checklist, a care bundle for PPH prevention, and a PPH treatment checklist. As patient empowerment tools a patient passport and an information website were developed. Professionals had no points for improvement concerning the tools. Patients commented on the website, and changes were made accordingly.

Discussion We developed a tailor-made strategy for PPH guideline implementation. The next step in the implementation process is to evaluate the feasibility of the strategy, including an effect, process and cost evaluation.

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