title: The Perinatal Birth Environment: Communication Strategies and Processes for Adherence to a Standardized Guideline in Women Undergoing Second-Stage Labor With Epidural Anesthesia.
abstract: Key to any perinatal safety initiative is buy-in and strong leadership from obstetric and pediatric providers, advanced practice nurses, and labor and delivery nurses in collaboration with ancillary staff. In the fall of 2007, executives of a large Midwestern hospital system created the Zero Birth Injury Initiative. This multidisciplinary group sought to eliminate birth injury using the Institute of Healthcare Improvement Perinatal Bundles. Concurrently, the team implemented a standardized second-stage labor guideline for women who choose epidural analgesia for pain management to continue the work of eliminating birth injuries in second-stage labor. The purpose of this article was to describe the process of the modification and adaptation of a standardized second-stage labor guideline, as well as adherence rates of these guidelines into clinical practice. Prior to implementation, a Web-based needs assessment survey of providers was conducted. Most (77% of 180 respondents) believed there was a need for an evidence-based guideline to manage the second stage of labor. The guideline was implemented at 5 community hospitals and 1 academic health center. Data were prospectively collected during a 3-month period for adherence assessment at 1 community hospital and 1 academic health center. Providers adhered to the guideline in about 57% of births. Of patients whose provider followed the guideline, 75% of women were encouraged to delay pushing compared with only 28% of patients delayed pushing when the provider did not follow the guideline.
authors.affiliation: University of Minnesota School of Nursing, Minneapolis (Drs Sommerness and Avery); University of Minnesota Masonic Children's Hospital, Minneapolis (Ms Gams); Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School (Drs Landers, Rauk and Shield), University of Minnesota School of Medicine, (Dr Millar), University of Minnesota School of Medicine, Minneapolis; Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis (Ms Bangdiwala); Allina Health System, Minneapolis, Minnesota (Dr Hirt); and Obstetrics and Gynecology Specialists, Edina, Minnesota (Dr Cho). Ms Miller is Quality Health Consultant at Lakeville, Minnesota.
authors.forename: Samantha A
authors.initials: SA
authors.lastname: Sommerness
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gams
authors.forename: Phillip N
authors.initials: PN
authors.lastname: Rauk
authors.forename: Ananta
authors.initials: A
authors.lastname: Bangdiwala
authors.forename: Daniel V
authors.initials: DV
authors.lastname: Landers
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Avery
authors.forename: Charles
authors.initials: C
authors.lastname: Hirt
authors.forename: Kristi
authors.initials: K
authors.lastname: Miller
authors.forename: Amy
authors.initials: A
authors.lastname: Millar
authors.forename: Suzin
authors.initials: S
authors.lastname: Cho
authors.forename: Andrea
authors.initials: A
authors.lastname: Shields
mesh_terms: D000767:Anesthesia, Epidural / Q000451:nursing*; D000773:Anesthesia, Obstetrical / Q000451:nursing; D036861:Delivery, Obstetric / Q000451:nursing*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration; D009773:Obstetric Nursing / Q000379:methods*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D014481:United States