Sprague Ann E, Oppenheimer Lawrence, McCabe Linda, Graham Ian D, Davies Barbara L
Perinatal Partnership Program of Eastern and Southeastern Ontario, Canada.
MCN Am J Matern Child Nurs. 2008 May-Jun;33(3):179-86; quiz 187-8. doi: 10.1097/01.NMC.0000318354.00859.41.
To quantify practice changes associated with implementing a clinical practice guideline for the second stage of labor in term nulliparous women with epidural anesthesia and to describe the lessons learned about knowledge translation. The main clinical practice guideline recommendation was waiting up to 2 hours before pushing after full dilatation.
Pre- and post-evaluation of clinical outcomes and knowledge translation strategies associated with implementing the second stage of labor clinical practice guideline at two birthing units within a large teaching hospital.
The implementation of the clinical practice guideline resulted in a significant increase in median waiting time before pushing of 33 minutes at Site 1. This change was also reflected in the twofold increase in the proportion of women waiting longer than 120 minutes before pushing at this site. There was no change in waiting time at Site 2. The duration of the second stage did not change significantly at either site. The median pushing time decreased at both sites but was only statistically significant at Site 1.
Bringing about practice change in obstetrics is complex. The measured change in this study was less than we expected. Greater success might have been achieved by enhancing feedback to care providers and more frequent audits of practice. We need to better understand the subtle influences in attitude and culture that prevented successful implementation in one site. For units considering a similar process, we recommend a commensurately greater level of presence in the units to encourage compliance with the clinical practice guideline in order to achieve the desired level of practice change.
量化与为足月未产妇实施硬膜外麻醉下第二产程临床实践指南相关的实践变化，并描述在知识转化方面吸取的经验教训。临床实践指南的主要建议是在宫口开全后等待长达2小时再用力。
对一家大型教学医院内两个分娩单元实施第二产程临床实践指南相关的临床结果和知识转化策略进行前后评估。
临床实践指南的实施导致1号地点用力前的中位等待时间显著增加33分钟。这一变化也反映在该地点用力前等待超过120分钟的女性比例增加了两倍。2号地点的等待时间没有变化。两个地点的第二产程持续时间均无显著变化。两个地点的中位用力时间均有所下降，但仅在1号地点具有统计学意义。
在产科实现实践改变很复杂。本研究中测得的变化小于我们的预期。通过加强对医护人员的反馈和更频繁的实践审核，可能会取得更大的成功。我们需要更好地理解态度和文化方面的细微影响，这些影响阻碍了在一个地点的成功实施。对于考虑类似流程的单位，我们建议在单位中投入相应更多的精力，以鼓励遵守临床实践指南，从而实现期望的实践改变水平。
