Impact of a quality improvement project to reduce the rate of obstetric anal sphincter injury: a multicentre study with a stepped‐wedge design

Gurol‐Urganci, Ipek; Bidwell, Posy; Sevdalis, Nick; Silverton, Louise; Novis, Vivienne; Freeman, RM; Hellyer, Alexandra; Meulen, Jan van der; Thakar, Ranee

doi:10.1111/1471-0528.16396

Cited by 57 publications

(41 citation statements)

References 35 publications

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“…Overview of results and strengths Demonstrated effectiveness in reducing OASI rates OASI1 demonstrated the care bundle's potential for reducing perineal trauma during childbirth. The clinical outcomes evaluation including 55,060 singleton, live, vaginal births found a reduction of 20% in the risk of OASI after the introduction of the care bundle (adjusted odds ratio 0.80, 95% confidence interval 0.65-0.98) [14]. The adjusted odds ratio represents relative differences in the odds of OASI before and after implementation of the care bundle, after accounting for time trends and case-mix factors (age, ethnicity, body mass index, parity, birthweight and mode of birth).…”

Section: Reflecting On the Results Strengths And Limitations Of Oasi1mentioning

confidence: 99%

“…Secondary clinical outcomes evaluated were episiotomy and caesarean birth rates. The clinical evaluation relied on routinely collected maternity data [14]. Secondary outcomes related to implementation of the care bundle, namely acceptability, coverage, feasibility and sustainability, were studied qualitatively through interviews and focus group discussions with clinicians and women who received the care bundle during birth.…”

Section: Overview Of Oasi1mentioning

confidence: 99%

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The OASI care bundle quality improvement project: lessons learned and future direction

et al. 2021

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Rising rates of obstetric anal sphincter injury (OASI) led to a collaborative effort by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) to develop and evaluate the OASI Care Bundle (OASI-CB). The OASI-CB comprises four practices (antenatal discussion about OASI, manual perineal protection, mediolateral episiotomy at 60° from the midline, and systematic examination of the perineum, vagina and ano-rectum after vaginal birth) and was initially implemented as part of a quality improvement (QI) project—“OASI1”—in 16 maternity units across Great Britain. Evaluation of the OASI1 project found that the care bundle reduced OASI rates and identified several barriers and enablers to implementation. This paper summarises the key findings, including strengths, limitations and lessons learned from the OASI1 QI project, and provides rationale for further evaluation of the OASI-CB.

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Section: Reflecting On the Results Strengths And Limitations Of Oasi1mentioning

confidence: 99%

Section: Overview Of Oasi1mentioning

confidence: 99%

The OASI care bundle quality improvement project: lessons learned and future direction

et al. 2021

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“…Even so, research notes that recall following birth remains high for a long period of time [24]. Fidelity to the OASI Care Bundle was not measured [22]; so, it is unclear whether the conditions and circumstances of this study were implemented in the same manner for all women. Given that the majority of women were multiparous, it is possible that their previous birth experience may have affected their perception of this birth.…”

Section: Limitationsmentioning

confidence: 98%

“…The overall impact of employing the OASI Care Bundle showed a reduction in OASI rates from 3.3% preimplementation to 3.0% post-implementation (p = 0.03), with > 55,000 women included in the analysis [22]. In addition to the clinical impact of the OASI Care Bundle, implementation strategies were evaluated to understand the barriers and enablers towards uptake within units [23].…”

Section: The Oasi Care Bundle Quality Improvement Projectmentioning

confidence: 99%

Women’s experiences of the OASI Care Bundle; a package of care to reduce severe perineal trauma

et al. 2021

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Introduction and hypothesis Obstetric anal sphincter injury (OASI) is a severe form of perineal trauma that can occur during vaginal birth. Long-term morbidities include anal incontinence and psychosocial disorders. To reduce these injuries within England, Scotland and Wales, the OASI Care Bundle was introduced to 16 maternity units (January 2017–March 2018). The OASI Care Bundle comprises four elements: (1) antenatal information, (2) manual perineal protection, (3) medio-lateral episiotomy (when indicated) and 4) recognition and diagnosis of tears. As part of the project evaluation, a qualitative study was conducted to explore women’s experiences of the OASI Care Bundle. Methods Semi-structured interviews were conducted with women (n = 19) who received the OASI Care Bundle as part of their maternity care. This was to explore their experience of each element. A thematic analysis of the interview data was performed. Results Three themes were identified: (1) memories of touch, whereby women reported that a ‘hands-on’ approach to perineal protection was a positive experience; (2) midwife as a supportive guide, where women reported that good communication facilitated a calm birth and post-birth diagnosis; (3) education: women need more information about perineal trauma. Conclusion This study contributes to the literature through its exploration of women’s experiences of perineal protection techniques and diagnosis of perineal trauma. Interviewed women indicated that they did not experience any of the care bundle elements as an intrusion of their physical integrity. Additionally, an urgent need was identified for more information about perineal trauma in terms of risk, prevention and recovery.

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“…A recent study in the UK had the objective of trying to evaluate the impact of a care bundle (antenatal information to women, manual perineal protection and mediolateral episiotomy when indicated) on OASI rates 1 . This was a multicenter stepped‐wedge cluster design, carried out in 16 maternity units across four regions in England, Scotland and Wales.…”

Section: Can a Care Bundle Reduce Obstetric Anal Sphincter Injury Rates?mentioning

confidence: 99%

Contemporary Issues in Women's Health

Geary

Chibwesha

Stringer

2021

Intl J Gynecology & Obste

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Impact of a quality improvement project to reduce the rate of obstetric anal sphincter injury: a multicentre study with a stepped‐wedge design

Cited by 57 publications

References 35 publications

The OASI care bundle quality improvement project: lessons learned and future direction

The OASI care bundle quality improvement project: lessons learned and future direction

Women’s experiences of the OASI Care Bundle; a package of care to reduce severe perineal trauma

Contemporary Issues in Women's Health

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