title: An audit of clinician compliance with best practice recommendations to repair severe obstetric anal sphincter injuries.
abstract: BACKGROUND
  Obstetric anal sphincter injuries occur uncommonly in Caribbean practice but are accompanied by substantial morbidity.
  
  
  OBJECTIVE
  To evaluate clinicians' compliance with management guidelines at a national referral hospital in Jamaica.
  
  
  METHODS
  Retrospective review of the records of all consecutive obstetric patients with anal sphincter injuries between November 1, 2007, and December 30, 2012.
  
  
  METHODS
  The primary end point was the completion of each of 8 tasks from existing management guidelines: 1) interdisciplinary consultation, 2) perineal examination with the patient under anesthesia, 3) injury repair in the operating room, 4) prophylactic antibiotics at induction, 5) repair by an experienced clinician, 6) repair method appropriate for injury grade, 7) slowly absorbable suture chosen for sphincter repair, and 8) rapidly absorbable suture for mucosal repair. We quantified clinician compliance with the guidelines by assigning a score of 1 for each task completed and 0 for an incomplete task. Individual task scores were summed. Clinicians were considered compliant when their overall score was above 6.
  
  
  RESULTS
  Twenty-six women (mean age = 27 years; standard deviation = 5.78 years) had obstetric anal sphincter injuries. Nine cases (34.6%) earned clinician compliance scores above 6, and 17 (65.4%) had scores of 6 or below. Experienced clinicians repaired all the injuries in this study-the only task for which compliance was 100%.
  
  
  CONCLUSIONS
  Despite attempts at improving therapeutic outcomes by creating tailored guidelines for repair of obstetric anal sphincter injuries, there is a serious barrier to success because 65% of senior clinicians were noncompliant.
authors.affiliation: Senior Lecturer in the Department of Clinical Surgical Sciences at the University of West Indies in Port of Spain, Trinidad and Tobago. socawich@hotmail.com.
authors.forename: Shamir O
authors.initials: SO
authors.lastname: Cawich
authors.affiliation: Obstetrician in the Department of Obstetrics and Gynecology at the University of West Indies in Kingston, Jamaica. santosh@cwjamaica.com.
authors.forename: Santosh
authors.initials: S
authors.lastname: Kulkarni
authors.affiliation: Lecturer in Clinical Surgical Sciences at the University of West Indies in St Augustine, Trinidad and Tobago. jimmyramdass@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Ramdass
authors.affiliation: Associate Lecturer in the Department of Clinical Surgical Sciences at the University of West Indies in St Augustine, Trinidad and Tobago. drdalehassranah@gmail.com.
authors.forename: Dale
authors.initials: D
authors.lastname: Hassranah
authors.affiliation: Obstetrician in the Department of Obstetrics and Gynecology at the University of West Indies in Kingston, Jamaica. ianbam12@hotmail.com.
authors.forename: Ian
authors.initials: I
authors.lastname: Bambury
authors.affiliation: Obstetrician in the Department of Obstetrics and Gynecology at the University of West Indies in Kingston, Jamaica. loxleychristie@hotmail.com.
authors.forename: Loxley R
authors.initials: LR
authors.lastname: Christie
authors.affiliation: Professor of Surgery in Clinical Surgical Sciences at the University of West Indies in St Augustine, Trinidad and Tobago. vnarayn@gmail.com.
authors.forename: Vijay
authors.initials: V
authors.lastname: Naraynsingh
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000293:injuries / Q000601:surgery; D019072:Antibiotic Prophylaxis; D054869:Clinical Audit; D002983:Clinical Competence / Q000592:standards*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D007563:Jamaica; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000601:surgery; D055815:Young Adult
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