title: Investigating antenatal corticosteroid clinical guideline practice at an organisational level.
abstract: BACKGROUND
  High-quality, evidence-based guidelines can improve the quality of health care and facilitate standardisation of practice within and across healthcare organisations. Limited information is known regarding existing antenatal corticosteroid (ACS) guideline practices within organisations across Australia and New Zealand.
  
  
  OBJECTIVE
  To assess existing ACS clinical practice guidelines (CPG). To describe current organisational practice related to the production, implementation and renewal of CPG.
  
  
  METHODS
  A cross-sectional survey of hospital practice using an online questionnaire.
  
  
  METHODS
  Clinical Managers at 27 secondary and 25 tertiary maternity hospitals, that contribute data to the Australia and New Zealand Neonatal Network, were approached from May to September 2015 and completed the questionnaire on behalf of their organisation.
  
  
  RESULTS
  Of the hospitals surveyed, 93% reported having a CPG or protocol. Of these, 89% of CPG included recommendations on a single course of ACS, 37% on the use of repeat course/s and 41% on use prior to elective caesarean section at term. Variation in the recommendations provided existed between countries and depending on the level of neonatal care provided. A guideline development group existed in 85% of hospitals. The preferred tools to facilitate implementation of a CPG include: email with a link to the hospital intranet, education sessions and an opinion leader. Only 28% of respondents reported auditing the use of ACS administration.
  
  
  CONCLUSIONS
  There is significant variation in the recommendations provided by current ACS CPGs. Utilisation of a single ACS CPG reflective of the current available evidence base may limit this variation.
authors.affiliation: Liggins Institute, The University of Auckland, Auckland, New Zealand.
authors.forename: Emma L
authors.identifier: http://orcid.org/0000-0001-6516-2252
authors.initials: EL
authors.lastname: McGoldrick
authors.affiliation: Liggins Institute, The University of Auckland, Auckland, New Zealand.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Brown
authors.affiliation: Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand.|National Women's Health, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Katie M
authors.initials: KM
authors.lastname: Groom
authors.affiliation: Liggins Institute, The University of Auckland, Auckland, New Zealand.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Crowther
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001315:Australia; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D005260:Female; D006771:Hospitals, Maternity / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D009520:New Zealand; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D016730:Program Development; D063728:Secondary Care Centers / Q000592:standards; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000592:standards
chemical_list: D000305:Adrenal Cortex Hormones
keywords: corticosteroids; health plan implementation; practice guidelines; premature birth