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Perm J. 2014 Summer;18(3):27-31. doi: 10.7812/TPP/13-167.

An audit of clinician compliance with best practice recommendations to repair severe obstetric anal sphincter injuries.

Author information

  • 1Senior Lecturer in the Department of Clinical Surgical Sciences at the University of West Indies in Port of Spain, Trinidad and Tobago. socawich@hotmail.com.
  • 2Obstetrician in the Department of Obstetrics and Gynecology at the University of West Indies in Kingston, Jamaica. santosh@cwjamaica.com.
  • 3Lecturer in Clinical Surgical Sciences at the University of West Indies in St Augustine, Trinidad and Tobago. jimmyramdass@gmail.com.
  • 4Associate Lecturer in the Department of Clinical Surgical Sciences at the University of West Indies in St Augustine, Trinidad and Tobago. drdalehassranah@gmail.com.
  • 5Obstetrician in the Department of Obstetrics and Gynecology at the University of West Indies in Kingston, Jamaica. ianbam12@hotmail.com.
  • 6Obstetrician in the Department of Obstetrics and Gynecology at the University of West Indies in Kingston, Jamaica. loxleychristie@hotmail.com.
  • 7Professor of Surgery in Clinical Surgical Sciences at the University of West Indies in St Augustine, Trinidad and Tobago. vnarayn@gmail.com.

Abstract

CONTEXT:

Obstetric anal sphincter injuries occur uncommonly in Caribbean practice but are accompanied by substantial morbidity.

OBJECTIVE:

To evaluate clinicians' compliance with management guidelines at a national referral hospital in Jamaica.

DESIGN:

Retrospective review of the records of all consecutive obstetric patients with anal sphincter injuries between November 1, 2007, and December 30, 2012.

MAIN OUTCOME MEASURES:

The primary end point was the completion of each of 8 tasks from existing management guidelines: 1) interdisciplinary consultation, 2) perineal examination with the patient under anesthesia, 3) injury repair in the operating room, 4) prophylactic antibiotics at induction, 5) repair by an experienced clinician, 6) repair method appropriate for injury grade, 7) slowly absorbable suture chosen for sphincter repair, and 8) rapidly absorbable suture for mucosal repair. We quantified clinician compliance with the guidelines by assigning a score of 1 for each task completed and 0 for an incomplete task. Individual task scores were summed. Clinicians were considered compliant when their overall score was above 6.

RESULTS:

Twenty-six women (mean age = 27 years; standard deviation = 5.78 years) had obstetric anal sphincter injuries. Nine cases (34.6%) earned clinician compliance scores above 6, and 17 (65.4%) had scores of 6 or below. Experienced clinicians repaired all the injuries in this study-the only task for which compliance was 100%.

CONCLUSION:

Despite attempts at improving therapeutic outcomes by creating tailored guidelines for repair of obstetric anal sphincter injuries, there is a serious barrier to success because 65% of senior clinicians were noncompliant.

PMID:
25102516
PMCID:
PMC4116262
DOI:
10.7812/TPP/13-167
[PubMed - indexed for MEDLINE]
Free PMC Article
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