%0 Journal Article
%T Increasing compliance with a clinical practice guideline for fetal fibronectin testing and the management of threatened preterm labour: A quality improvement project.
%A Dawes LK
%A Subramoney M
%A Miller LM
%A Groom KM
%J Eur J Obstet Gynecol Reprod Biol
%V 221
%N 0
%D Feb 2018
%M 29275278
%F 2.831
%R 10.1016/j.ejogrb.2017.12.017
%X <B>OBJECTIVE: </B>To increase adherence to a local hospital clinical practice guideline for the use of fetal fibronectin testing in women presenting with symptoms of threatened preterm labour.<BR><B>METHODS: </B>A quality improvement project using a multi-faceted implementation strategy.<BR><B>METHODS: </B>National Women's Health, Auckland City Hospital; a tertiary referral maternity unit in Auckland, New Zealand.<BR><B>METHODS: </B>All obstetricians, junior obstetric doctors and hospital employed midwives.<BR><B>METHODS: </B>A pre-education audit and survey, compulsory interactive educational intervention with audit feedback and provision of reminders followed by a post-education audit and survey one year later.<BR><B>METHODS: </B>Number of fetal fibronectin tests performed, proportion of tests performed meeting clinical criteria for testing and proportion of results managed according to hospital guideline.<BR><B>RESULTS: </B>There was a 25% increase in the number of tests performed with an increase in the proportion that met clinical criteria for testing, 76% (31/41)-93% (51/55) (OR 4.1, 95% CI 1.2-14.2). Adherence to guidelines for clinical management according to fFN results changed over time, 80% (33/41)-95% (52/55) (OR 4.2, 95% CI 1.04-17.0). Clinician knowledge on some (but not all) indications for fFN testing improved. Education and reminders did not improve understanding of clinical scenarios that may result in a false positive fFN test.<BR><B>CONCLUSIONS: </B>A multi-faceted approach of audit and clinician feedback, interactive education and reminders supports the implementation of a clinical practice guideline for the use of fFN as a preterm birth prediction test for women presenting with symptoms of threatened preterm labour.