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Abstract：
Key to any perinatal safety initiative is buy-in and strong leadership from obstetric and pediatric providers, advanced practice nurses, and labor and delivery nurses in collaboration with ancillary staff. In the fall of 2007, executives of a large Midwestern hospital system created the Zero Birth Injury Initiative. This multidisciplinary group sought to eliminate birth injury using the Institute of Healthcare Improvement Perinatal Bundles. Concurrently, the team implemented a standardized second-stage labor guideline for women who choose epidural analgesia for pain management to continue the work of eliminating birth injuries in second-stage labor. The purpose of this article was to describe the process of the modification and adaptation of a standardized second-stage labor guideline, as well as adherence rates of these guidelines into clinical practice. Prior to implementation, a Web-based needs assessment survey of providers was conducted. Most (77% of 180 respondents) believed there was a need for an evidence-based guideline to manage the second stage of labor. The guideline was implemented at 5 community hospitals and 1 academic health center. Data were prospectively collected during a 3-month period for adherence assessment at 1 community hospital and 1 academic health center. Providers adhered to the guideline in about 57% of births. Of patients whose provider followed the guideline, 75% of women were encouraged to delay pushing compared with only 28% of patients delayed pushing when the provider did not follow the guideline.
摘要：
任何围产期安全举措的关键是产科和儿科提供者的支持和强有力的领导，高级执业护士，以及与辅助人员合作的劳动和分娩护士。2007年秋天，中西部一家大型医院系统的高管创建了“零出生伤害倡议”。这个多学科小组试图使用医疗保健改善围产期束研究所消除出生伤害。同时,该团队为选择硬膜外镇痛进行疼痛管理的女性实施了标准化的第二产程指南,以继续消除第二产程中的分娩损伤.本文的目的是描述标准化的第二阶段劳动准则的修改和适应过程，以及这些指南在临床实践中的依从率。在实施之前，对提供者进行了基于网络的需求评估调查.大多数（180名受访者中的77％）认为需要基于证据的指南来管理第二阶段的分娩。该指南在5家社区医院和1家学术健康中心实施。数据是在3个月的时间内前瞻性收集的，用于在1家社区医院和1家学术健康中心进行依从性评估。服务提供者在约57％的分娩中遵守了该指南。在提供者遵循指南的患者中，75％的女性被鼓励推迟推动，而只有28％的患者在提供者不遵循指南时推迟推动。
