Application of Agree II Instrument for Appraisal of Postpartum Hemorrhage Clinical Practice Guidelines in Bosnia and Herzegovina

Abstract

Introduction:Federal Minister of Health and Minister of Health and Social Welfare of the Republika Srpska as a Governmental health authorities in Federation of Bosnia and Herzegovina (FBiH) and the Republika Srpska nominated/appointed health professionals as their representatives to a multidisciplinary Guidelines Adaptation Group (GAG). This group started with its work in September 2015. The main purpose of the guidelines development exercise is to develop guidelines with worldwide recognized methodology for clinical guidelines development and adaptation. At the end of this consultancy, GAG would have develop a clinical practice guideline on Postpartum hemorrhage (PPH) through the adaptation method, starting from published international clinical guidelines and adapting it according to the country specific requirements.Methodology:During the process of identifying the best guideline for adaptation, the GAG had to pass several steps. One of the crucial steps was to identify the questions related to clinical practice and health policy for which answers are needed to be addressed by the guideline. These questions included relevant issues regarding the topic area such as diagnosis, prognosis, intervention, service delivery, and training. After that, six guidelines have been researched by the six members of the GAG to see if they answered the identified questions. Evaluating the methodological quality of the selected clinical guidelines was a second essential step before deciding which ones could best fit the needs and interests. AGREE II instrument has been chosen as methods for evaluating clinical guideline quality and appropriateness. Four appraisers conducted the assessment of each of the selected guidelines for PPH. All appraisers passed the training for the AGREE II instrument before conducting appraisals, as recommended by the AGREE collaboration. Each of the four guidelines was rated independently with the AGREE II tool by each appraiser.Results:The highest score was obtained by the WHO recommendations for postpartum hemorrhage guidelines and each of four assessors recommended it to be adapted and further implemented.Discussion:In spite of several serous attempts and two Agencies for quality improvement in BiH the whole process of guideline adaptation is still in the beginning and therefore the establishment of a strong connection with similar institutions and organizations from our region and the rest of the world is very important. Cooperation and collaboration across institutions and countries and key stakeholders have potential to significantly improve the validity and quality of the adapted guidelines and to positively influence implementation.

Postpartum Hemorrhage: A Technical Essay

“…PPH is considered primary if bleeding occurs within the first 24 hours after delivery. Secondary PPH occurs between 24 hours and 12 weeks after delivery [29] [30]. PRIMARY PPH occurs in approximately 70% of cases and is related to uterine atony in the third stage of delivery.…”

“…The ACGO (2017) [27] Practice Bulletin notes that, although visually estimated blood loss is considered imprecise, the use of an educational process on blood loss estimation for practitioners has been shown to improve the accuracy of such estimates. Massive PPH refers to the loss of 30%-40% of the patient's blood volume [29] [31].…”

Clinical practice guidelines appraisal and utilisation by Pharm.D. students

“…As information was insufficient and just one item in Domain 6: Editorial Independence, the authors could not derive a conclusion on it. Capacity building and collaborative efforts are necessary to increase the application of best quality evidence from appropriate guidelines (Novo et al, 2016).…”

<p>Clinical Guideline for Nursing Care of Children with Head Trauma (HT): Study Protocol for a Sequential Exploratory Mixed-Method Study</p>

“…They also gave an overall assessment of the guideline from 1 (lowest) to 7 (highest) and were asked to state if they would recommend the guideline, recommend it with modifications or not. Average appraisal scores were calculated for each appraiser by taking the average rating 25 for all items of a single guideline. Percentages for each domain were then calculated will be done by adding all six appraiser ratings of items in a single domain (obtained score) and scaling to the maximum and minimum possible domain scores and converting to a percentage.…”