Assessment of the quality, content and perceived utility of local maternity guidelines in hospitals in England implementing the Saving Babies’ Lives Care Bundle to reduce stillbirth

Introduction

The UK Department of Health have targeted a reduction in stillbirth by 50% by 2025; to achieve this, the first version of the Saving Babies Lives Care Bundle (SBLCB) was developed by NHS England in 2016 to improve four key areas of antenatal and intrapartum care. Clinical practice guidelines are a key means by which quality improvement initiatives are disseminated to frontline staff.

Methods

Seventy-five clinical practice guidelines covering the four areas of antenatal and intrapartum care in the first version of SBLCB were obtained from 19 maternity providers. The content and quality of guidelines were evaluated using the AGREE II tool. Maternity health professionals in participating organisations were invited to participate in an anonymous survey to determine perceptions towards and experiences of the use of clinical practice guidelines using a series of Likert scales.

Results

Unit guidelines showed considerable variation in quality with median scores 50%-58%. Only 4 (5.6%) guidelines were recommended for use in clinical practice without modifications, 54 (75.0%) were recommended for use subject to modifications and 12 (16.7%) were not recommended for use. The lowest scoring domains were ‘rigour of development’, ‘stakeholder involvement’ and ‘applicability’. A significant minority of unit guidelines omitted recommendations from national guidelines. The majority of staff believed that clinical practice guidelines standardised and improved the quality of care but over 30% had insufficient time to use them and 24% stated they were unable to implement recommendations.

Conclusion

Change is needed to local clinical practice guidelines to reduce variation in quality and to ensure they are consistent with national recommendations. In addition, to improve clinical practice, adequate time and resources need to be in place to deliver and evaluate care recommended in the SBLCB.