Investigating antenatal corticosteroid clinical guideline practice at an organisational level

Abstract

Background: High-quality, evidence-based guidelines can improve the quality of health care and facilitate standardisation of practice within and across healthcare organisations. Limited information is known regarding existing antenatal corticosteroid (ACS) guideline practices within organisations across Australia and New Zealand.

Aims: To assess existing ACS clinical practice guidelines (CPG). To describe current organisational practice related to the production, implementation and renewal of CPG.

Design: A cross-sectional survey of hospital practice using an online questionnaire.

Methods: Clinical Managers at 27 secondary and 25 tertiary maternity hospitals, that contribute data to the Australia and New Zealand Neonatal Network, were approached from May to September 2015 and completed the questionnaire on behalf of their organisation.

Results: Of the hospitals surveyed, 93% reported having a CPG or protocol. Of these, 89% of CPG included recommendations on a single course of ACS, 37% on the use of repeat course/s and 41% on use prior to elective caesarean section at term. Variation in the recommendations provided existed between countries and depending on the level of neonatal care provided. A guideline development group existed in 85% of hospitals. The preferred tools to facilitate implementation of a CPG include: email with a link to the hospital intranet, education sessions and an opinion leader. Only 28% of respondents reported auditing the use of ACS administration.

Conclusions: There is significant variation in the recommendations provided by current ACS CPGs. Utilisation of a single ACS CPG reflective of the current available evidence base may limit this variation.

Keywords: corticosteroids; health plan implementation; practice guidelines; premature birth.