title: Decreased rates of shoulder dystocia and brachial plexus injury via an evidence-based practice bundle.
abstract: OBJECTIVE
  To evaluate whether a standardized approach to identify pregnant women at risk for shoulder dystocia (SD) is associated with reduced incidence of SD and brachial plexus injury (BPI).
  
  
  METHODS
  Between 2011 and 2015, prospective data were collected from 29 community-based hospitals in the USA during implementation of an evidence-based practice bundle, including an admission risk assessment, required "timeout" before operative vaginal delivery (OVD), and low-fidelity SD drills. All women with singleton vertex pregnancies admitted for vaginal delivery were included. Rates of SD, BPI, OVD, and cesarean delivery were compared between a baseline period (January 2011-September 2013) and an intervention period (October 2013-June 2015), during which there was a system-wide average bundle compliance of 90%.
  
  
  RESULTS
  There was a significant reduction in the incidence of SD (17.6%; P=0.028), BPI (28.6%; P=0.018), and OVD (18.0%; P<0.001) after implementation of the evidence-based practice bundle. There was a nonsignificant reduction in primary (P=0.823) and total (P=0.396) cesarean rates, but no association between SD drills and incidence of BPI.
  
  
  CONCLUSIONS
  Implementation of a standard evidence-based practice bundle was found to be associated with a significant reduction in the incidence of SD and BPI. Utilization of low-fidelity drills was not associated with a reduction in BPI.
authors.affiliation: Department of Obstetrics and Gynecology, University of California Davis, Sacramento, CA, USA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Sienas
authors.affiliation: Department of Obstetrics and Gynecology, University of California Davis, Sacramento, CA, USA.|Sacramento Maternal-Fetal Medicine Medical Group, Sacramento, CA, USA.
authors.forename: Herman L
authors.initials: HL
authors.lastname: Hedriana
authors.affiliation: Patient Safety, Dignity Health, San Francisco, CA, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Wiesner
authors.affiliation: Patient Safety, Dignity Health, San Francisco, CA, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pelletreau
authors.affiliation: Department of Obstetrics and Gynecology, University of California Davis, Sacramento, CA, USA.
authors.forename: Machelle D
authors.initials: MD
authors.lastname: Wilson
authors.affiliation: Patient Safety, Dignity Health, San Francisco, CA, USA.|Maternal-Fetal Medicine, Marian Regional Medical Center, Santa Maria, CA, USA.
authors.forename: Laurence E
authors.initials: LE
authors.lastname: Shields
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology*; D001917:Brachial Plexus / Q000293:injuries*; D002585:Cesarean Section / Q000706:statistics & numerical data; D004420:Dystocia / Q000453:epidemiology*; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D061214:Patient Safety / Q000592:standards*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012782:Shoulder; D014481:United States
keywords: Brachial plexus injury; Patient safety; Shoulder dystocia