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Do national guidelines affect local practice in a timely manner? assessment of the rcog guideline on the management of stillbirth
  1. EK Hall1,
  2. A Heazell2,
  3. MK Whitworth3
  1. 1University of Manchester, Manchester, United Kingdom
  2. 2Manchester Academic Health Science Centre/Maternal & Fetal Health Research Centre, University of Manchester, Manchester, United Kingdom
  3. 3St Mary's Hospital, Central Manchester NHS Foundation Trust, Manchester, United Kingdom

Abstract

Background NHS clinical effectiveness initiatives aim to promote uniform standards of high-quality, evidence-based care. Clinical practice guidelines produced by the RCOG are a principal component of such care. We aimed to determine if the publication of a RCOG guideline on ‘Late Intrauterine Fetal Death and Stillbirth’ in October 2010 has translated into the development of evidence-based policies for management of stillbirths in obstetric units throughout the UK.

Method UK maternity units were requested to provide a copy of their guideline for the management of stillbirth. Fourteen audit criteria were agreed by committee, based on the strongest evidence reviewed by the RCOG guideline. Guidelines were then audited to assess concurrence with these criteria.

Results Guidelines were obtained from 40.2% of units contacted. Individual guidelines were of varying length (2-68 pages), depth and quality. No unit policies contained all 14 recommendations taken from the RCOG guideline. The median number of recommendations contained in a unit guideline was 4 (range 1-10). The most frequently included recommendation was ‘maternity units should have the facilities for producing photographs, palm and foot prints’ (89.1%). The level A recommendation ‘women should be advised vaginal misoprostol is as effective as oral therapy but associated with fewer adverse side effects’ was included in only 10.9% of guidelines, with 63.6% not mentioning how misoprostol should be administered.

Conclusion The translation of RCOG guidance into effective clinical practice is variable. Research is needed to determine how improvements can be made to ensure that grade A evidence is translated into practice.

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