Komolafe Abiola Olubusola, Olajubu Aanuoluwapo Omobolanle, Ijarotimi Omotade Adebimpe, Ogunlade Oluwasayo Bolarinwa, Olowokere Adekemi Eunice, Irinoye Omolola Oladunni
Department of Nursing Science, Obafemi Awolowo University, Ile-Ife, Nigeria.
Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria.
SAGE Open Nurs. 2024 Jan 10;10:23779608231226064. doi: 10.1177/23779608231226064. eCollection 2024 Jan-Dec.
While practice guidelines support clinical decision-making for optimal patient outcomes, there is often nonadherence to practice guidelines in implementing evidence-based interventions.
This article aimed to assess adherence to practice guidelines in emergency obstetric and newborn care (EmONC) and the outcome of pregnancy in cases of obstetric complications in referral hospitals.
The study employed a descriptive design. A purposive sampling technique was used to select the three tertiary hospitals and six out of nine state hospitals in Osun State. A data extraction form developed based on a fidelity framework was used to collect data on Adherence from 264 cases of obstetric complications. Descriptive statistics, such as frequency and percentage, and inferential statistics, such as chi-square, were done with the significance level set as < .05.
Findings showed low adherence to practice guidelines in 70.8% of hemorrhage care, 52.0% of fetal distress care, 60.0% of prolonged obstructed labor care, and 44.4% of preeclampsia/eclampsia care. The study's findings also showed that 64.3% of cases of prolonged/obstructed labor, 54.9% of cases of fetal distress, and 46.7% of all cases of obstetric complications were referred out at the state hospitals. Neonatal mortality in state and tertiary hospitals was 3.7% and 21.7%, respectively, which was significantly different ( < .001).
There was low adherence to practice guidelines for the implementation of EmONC in state and tertiary hospitals, and a significant number of cases of obstetric complications were referred out in the state hospitals. The low adherence to practice guidelines and numerous referrals truncate the successful implementation of EmONC and hinder women and newborns from receiving optimal care for obstetric complications. There is a need to develop strategies that promote adherence to practice guidelines in implementing EmONC.
虽然实践指南有助于临床决策以实现最佳患者预后，但在实施循证干预措施时，往往存在不遵守实践指南的情况。
本文旨在评估转诊医院在产科急诊和新生儿护理（EmONC）中对实践指南的遵守情况以及产科并发症病例的妊娠结局。
本研究采用描述性设计。采用目的抽样技术，选取了奥孙州的三家三级医院和九家州立医院中的六家。基于保真度框架开发的数据提取表用于收集264例产科并发症病例的依从性数据。进行了描述性统计，如频率和百分比，以及推断性统计，如卡方检验，显著性水平设定为<0.05。
研究结果显示，在出血护理中，70.8%的病例对实践指南的遵守情况较差；胎儿窘迫护理中为52.0%；产程延长梗阻性分娩护理中为60.0%；先兆子痫/子痫护理中为44.4%。研究结果还显示，64.3%的产程延长/梗阻性分娩病例、54.9%的胎儿窘迫病例以及46.7%的所有产科并发症病例在州立医院被转诊。州立医院和三级医院的新生儿死亡率分别为3.7%和21.7%，差异有统计学意义（<0.001）。
州立医院和三级医院在实施EmONC时对实践指南的遵守情况较差，且州立医院有大量产科并发症病例被转诊。对实践指南的低遵守率和大量转诊阻碍了EmONC的成功实施，也妨碍了妇女和新生儿获得针对产科并发症的最佳护理。有必要制定策略，以促进在实施EmONC时遵守实践指南。
