荷兰基层助产护理中预防和管理产后出血的质量指标的制定。
The development of quality indicators for the prevention and management of postpartum haemorrhage in primary midwifery care in the Netherlands.
机构信息
Department of Obstetrics, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands.
出版信息
BMC Pregnancy Childbirth. 2013 Oct 20;13:194. doi: 10.1186/1471-2393-13-194.
BACKGROUND
At present, there are no guidelines on prevention and management of postpartum haemorrhage in primary midwifery care in the Netherlands. The first step towards implementing guidelines is the development of a set of quality indicators for prevention and management of postpartum haemorrhage for primary midwifery supervised (home) birth in the Netherlands.
METHODS
A RAND modified Delphi procedure was applied. This method consists of five steps: (1) composing an expert panel (2) literature research and collection of possible quality indicators, (3) digital questionnaire, (4) consensus meeting and (5) critical evaluation. A multidisciplinary expert panel consisting of five midwives, seven obstetricians and an ambulance paramedic was assembled after applying pre-specified criteria concerning expertise in various domains relating to primary midwifery care, secondary obstetric care, emergency transportation, maternal morbidity or mortality audit, quality indicator development or clinical guidelines development and representatives of professional organisations.
RESULTS
After literature review, 79 recommendations were selected for assessment by the expert panel. After a digital questionnaire to the expert panel seven indicators were added, resulting in 86 possible indicators. After excluding 41 indicators that panel members unanimously found invalid, 45 possible indicators were assessed at the consensus meeting. During critical evaluation 18 potential indicators were found to be overlapping and two were discarded due to lack of measurability.
CONCLUSIONS
A set of 25 quality indicators was considered valid for testing in practice.
背景
目前，荷兰初级助产护理中尚无产后出血预防和管理指南。实施指南的第一步是为荷兰初级助产监督（家庭）分娩制定一套产后出血预防和管理质量指标。
方法
应用 RAND 修改后的 Delphi 程序。该方法包括五个步骤：（1）组成专家小组；（2）文献研究和可能质量指标的收集；（3）数字问卷调查；（4）共识会议；（5）批判性评估。在应用与初级助产护理、二级产科护理、紧急运输、孕产妇发病率或死亡率审核、质量指标制定或临床指南制定相关的各个领域的专业知识的特定标准后，组建了一个由五名助产士、七名产科医生和一名救护车护理人员组成的多学科专家小组。
结果
文献回顾后，选择了 79 项建议供专家小组评估。经过对专家小组的数字问卷调查，增加了 7 项指标，得到了 86 项可能的指标。排除小组一致认为无效的 41 项指标后，在共识会议上评估了 45 项可能的指标。在批判性评估过程中，发现 18 个潜在指标存在重叠，由于缺乏可衡量性，有两个指标被丢弃。
结论
一套 25 项质量指标被认为可在实践中进行测试。
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