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Cesarean Births Rates after Implementation of Labor Management Guidelines

机译：实施《劳动管理指南》后的剖宫产率

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摘要

Cesarean birth rates are associated with increased maternal morbidity. This project evaluated a quality improvement (QI) initiative implemented to reduce cesarean births among Nulliparous Term Singleton Vertex (NTSV) obstetric populations, the largest contributor to cesarean births. Variations in labor management practice contribute to cesarean birth rate; implementation of labor management bundles have been endorsed to influence practice- and system-level changes in the promotion of vaginal births. The problem addressed in this project was an organizational NTSV cesarean section rate of 30%. The purpose of the project was to use secondary data to evaluate a previously implemented labor management bundle at a large hospital in the northwestern United States. The model of improvement was used as a framework for the QI initiative and this evaluation project. The practice-focused question asked in this project was: Did NTSV cesarean birth rates change after implementation of an evidenced-based standardized labor management bundle? Archived data were collected on cesarean birth rates for 3 time periods: prebaseline, 1 year postimplementation, and 2 years postimplementation. Chi-square? tests compared the differences between observed and expected results of data following implementation of labor management bundles. Results show no statistically significant difference between the pre- and post- implementation periods in the NTSV laboring population. Results suggest use of labor management practice bundles alone may not lead to expected outcomes improvements and that operationalization of such practices are sensitive to institutional and/or patient population contexts. This project may serve to promote positive social change by framing evidence-based practice as a process that must attend to contextual considerations.
机译：剖宫产的出生率与产妇发病率增加有关。该项目评估了一项旨在降低剖宫产最大贡献者的产妇单核顶点（NTSV）剖宫产的质量改进（QI）计划。劳动管理实践的差异会导致剖宫产。劳工管理捆绑的实施已得到认可，以影响促进阴道分娩的实践和系统层面的变化。该项目解决的问题是组织性NTSV剖宫产率为30％。该项目的目的是使用辅助数据来评估美国西北部一家大型医院以前实施的劳工管理工具包。改进模型被用作QI计划和此评估项目的框架。在该项目中，以实践为中心的问题是：在实施基于证据的标准化劳动管理束之后，NTSV剖宫产率是否发生了变化？收集了三个时间段剖宫产率的存档数据：基线前，实施后1年和实施后2年。卡方？测试比较了劳动力管理工具包实施后数据的观察结果与预期结果之间的差异。结果显示，在NTSV劳动人口中，实施前和实施后之间没有统计学上的显着差异。结果表明，仅使用劳工管理措施组合可能不会导致预期结果的改善，并且此类措施的实施对机构和/或患者人群情况敏感。该项目可能通过将基于证据的实践构架为必须考虑到环境因素的过程，从而促进积极的社会变革。

著录项

  • 作者

    Bridges, Margie.;

  • 作者单位

    Walden University.;

  • 授予单位 Walden University.;
  • 学科 Nursing.;Health sciences.;Obstetrics.
  • 学位 D.N.P.
  • 年度 2018
  • 页码 74 p.
  • 总页数 74
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 建筑科学;
  • 关键词

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