Rasmussen Ole Bredahl, Yding Annika, Anh Ø Jacob, Sander Andersen Charlotte, Boris Jane
Department of Obstetrics and Gynaecology, Hospitalsenheden Vest, Herning, Denmark.
Centre of Diagnostic Investigation, Rigshospitalet, University of Copenhagen, Denmark.
BMJ Qual Improv Rep. 2016 Dec 19;5(1). doi: 10.1136/bmjquality.u217936.w7106. eCollection 2016.
A main concern for women giving birth is the risk of obstetric anal sphincter injuries. In our department the incidence of sphincter injuries was around 8 % among vaginally delivering first time mothers. We aimed to halve the incidence to 4 % or less. A prospective interventional program was instituted. We implemented a hands-on technique with four elements in a bundle of care together with a certification process for all staff on the delivery ward. The incidence of episiotomies served as a balancing indicator. The adherence to three of the four elements of the care bundle rose significantly while the all-or-nothing indicator leveled around 80 %. The median number of deliveries between cases with a sphincter injury increased from 9.5 in the baseline period to 20 during the intervention period. This corresponded with a reduction in the incidence from 7.0 % to 3.4 %. The rate of episiotomy remained low at 8.4 % in this group. By implementing the hands-on technique, we halved the risk of obstetric anal sphincter injuries. Our data suggest that further improvement may be anticipated. The study has demonstrated how implementation of a hands-on technique can be carried out within a quality improvement framework with rapid and sustainable results.
分娩女性主要关心的问题之一是产科肛门括约肌损伤的风险。在我们科室，首次经阴道分娩的产妇中括约肌损伤的发生率约为8%。我们的目标是将发生率减半至4%或更低。为此制定了一项前瞻性干预计划。我们实施了一项包含四个要素的实践技术，并将其纳入一系列护理措施中，同时对产房所有工作人员进行认证。会阴切开术的发生率作为一个平衡指标。四项护理要素中的三项要素的依从性显著提高，而全或无指标稳定在80%左右。括约肌损伤病例之间的分娩中位数从基线期的9.5例增加到干预期的20例。这相应地使发生率从7.0%降至3.4%。该组会阴切开术的发生率仍较低，为8.4%。通过实施该实践技术，我们将产科肛门括约肌损伤的风险减半。我们的数据表明有望进一步改善。该研究表明了如何在质量改进框架内实施实践技术并取得快速且可持续的成果。
