484 / Audit on c-section for dystocia

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Diagnostics
Medication / IV Fluids There is no specified text here
Topic of the reported practice
Clinical guidelines or pathways
Aim and the benefit of the Patient Safety Practice
 
Data from literature raise concern about the ever increasing incidence of C-sections. In Italy, both the Ministry of Health and the Regions are paying particular attention to the matter.The incidence of cesarean section has been raising over the last 10 years. The management of labour and delivery is changing and the labour curve described by Freeman are under revaluation. Our aim is to reduce the incidence of cesarean section for dystocia that represent a diagnosis most of the time uncorrected.
Description of the Patient Safety Practice
 
The project enabled to evaluate, through audit methodology and basing on international guidelines, how often and in which way we go against the recommendations in these guidelines in the low-risk nulliparous women group in whom c-section were done because of dystocia. Furthermore, thanks to the introduction of an audit form, we want to analyze whether compliance with international guidelines on management of dystocia may be associated with a reduction in the number of c-sections. The practice is also based on the adoption of a new scheme of infusion of oxytocin by an infusion pump and a procedure that provides at least 4 hours of infusion of oxytocin before formulate the diagnosis of cervical dystocia. Patient and/or citizen associations have not been involved in this phase.
Evaluation process: In the first part of the work has been analyzed the period from 1 January 2009 to 1 February 2010 taking into consideration women undergoing cesarean section for dystocia in cervical in the Unit of Obstetrics and Gynecology of Hospital Carlo Poma in Mantua. In the prospective study which is the second part of the work, the data were obtained via an ad hoc audit scheme whose compilation was carried out by the operators of department from 1 August 2010 to 30 September 2010. In the retrospective study were analyzed 38 folders. In the prospective study were collected 6 cases of dystocia. Data analysis highlighted adhesion to the proposed protocols . The adoption of the cartogram to 4 hours (as proposed by WHO) has reduced the incidence of TC for dystocia (from 37% in 2009 to 31% of the 2010 until September).
Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Point of time in which service user or their reprasentatives' involvement takes place
During implementation of the Patient Safety Practices
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
Yes
Short description of the service users' level of involvement
Consultation, such as asking for information
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/practicesdetail.aspx
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Regular data feed back to involved staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: Marzia Maini, Paolo Zampriolo, Enrico Burato
Country: ITALY
Organisation: A.O. `CARLO POMA` - MANTOVA
E-mail: marzia.maini@aopoma.it
Phone: 0376 201699
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