title: Uptake of a Guideline for the Administration of a Rescue Course of Antenatal Corticosteroids.
abstract: To evaluate use (both appropriate and inappropriate) of rescue corticosteroids before and after the implementation of a guideline for their use.
  
  
  
  We conducted a retrospective cohort study using a pharmacy log to identify women who received an initial course of antenatal corticosteroids in the year before (2008) and in the 4 years (2009-2012) after implementation of the guideline. The charts were then reviewed to determine eligibility and assess receipt of rescue corticosteroids according to the guideline. Our primary study outcome was a temporal change in the percentage of appropriate rescue corticosteroid administration.
  
  
  
  Of 2,528 women who received a first course of corticosteroids, 142 (5.6%) were eligible for a rescue course, of whom 103 (73%) received it. The rate of appropriate administration increased from 18.2% (95% confidence interval [CI] 5-40%) in 2008 to 65.4% (95% CI 44-83%) in 2009, 93.5% (95% CI 79-99%) in 2010, 96.1% (95% CI 80-99%) in 2011, and 75.7% (95% CI 59-88%) in 2012 (P for test of trend <.001). Only 25 of these 103 eligible women (24.3%) delivered within 2-7 days of receipt of the rescue course. The rate of inappropriate administration among women who were not eligible for a rescue course (n=2,381) also rose from 0.4% (95% CI 0.04-1.4%) in 2008 to 1.9% (95% CI 0.9-3.5%) in 2009, 1.8% (95% CI 0.8-3.6%) in 2010, 2.4% (95% CI 1.2-4.3%) in 2011, and 2.2% (95% CI 1.1-4.0%) in 2012 (P for test of trend=.03). Among all recipients of rescue corticosteroids, 28% (41/144) were ineligible according to the guideline.
  
  
  
  Implementation of an institutional guideline for rescue corticosteroids was associated with a high rate of use among eligible women.
authors.affiliation: Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island.
authors.forename: Ilina
authors.initials: I
authors.lastname: Datkhaeva
authors.forename: Danielle
authors.initials: D
authors.lastname: Dray
authors.forename: Phinnara
authors.initials: P
authors.lastname: Has
authors.forename: Bianca
authors.initials: B
authors.lastname: Stifani
authors.forename: Brenna L
authors.initials: BL
authors.lastname: Hughes
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
mesh_terms: D000328:Adult; D001623:Betamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004608:Eligibility Determination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D054539:Medication Therapy Management / Q000706:statistics & numerical data / Q000639:trends; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D014481:United States
chemical_list: D005938:Glucocorticoids; D001623:Betamethasone