1. A review of the first edition of The Obstetric Guidelines 2011-13
Dr Adil Todiwala (FY1)
Miss Radha Indusekhar (Consultant)
Sarah Carnwell (Network Administrator)

2. Introduction
Evidenced-based medicine is rapidly becoming more embedded in the practice of clinical medicine.
Clinical guidelines are quickly emerging in almost all wards and clinical environments, and the familiarity and dependency of them are growing.
The first edition of The Bedside Clinical Guidelines Partnership: Obstetric Guidelines has been published in February 2011.
It was compiled as an aide-memoir for all staff concerned with obstetric management, with the aim of standardising patient care.

3. Dudley Group of Hospitals NHS Trust
Mid Staffordshire General Hospital NHS Trust
The Royal Wolverhampton Hospitals NHS Trust
The Shrewsbury and Telford Hospitals NHS Trust
University Hospital of North Staffordshire
Walsall Hospitals NHS Trust 3

4. Aims & Objectives
Determine if the guidelines meet with the requirements of the obstetric staff.
Determine the awareness and usage of these guidelines amongst the obstetric staff.
Assess the usefulness and ease of the guidelines.
Evaluate the guidelines in a way which can help direct the development of further editions.

5. Methods Data collection: by questionnaire.
Members of obstetric staff included:
Doctors (Consultants, Specialist Registrars, SHO, FY1/2)
Midwives
Advanced Nurse Practitioners
Others (Medical Student, Student Midwife)

6. Methods Centres included: University Hospital of North Staffordshire
Shrewsbury and Telford
Walsall Manor
Mid Staffordshire General
Royal Wolverhampton
Dudley Group Hospitals 6

7. 7

8. Data Collection Consultant 8 Specialist Registrar 11 SHO 4 FY1 2
Midwife 31
Student Midwife 3
Medical Student 1
University Hospital of North Staffordshire 40
Mid Staffordshire General Hospital
Royal Wolverhampton Hospital 5
Shrewsbury and Telford 2
Dudley Group of Hospitals
Walsall Manor Hospital 12
Other (Keele University) 1
Medical Staff 25
Nursing Staff 31
Other 4

9. Are you aware of the Obstetric Guidelines?
100 90 50
Response
Medical Staff
(n=25)
Nursing Staff
(n=31)
Other
(n=4)
Total (%)
(n=60)
Yes 25 28 2
55 (92%) No - 3
5 (8%)

10. Have you seen a copy of the Obstetric Guidelines?
100 80 25
Response
Medical Staff
(n=25)
Nursing Staff
(n=31)
Other
(n=4)
Total (%)
(n=60)
Yes 25 1
51 (85%) No - 6 3
9 (15%)

11. In what form have you seen a copy of the Obstetric Guidelines?26 29
100 74 70
Response
Medical Staff
(n=34)
Nursing Staff
(n=31)
Other
(n=1)
Total (%)
(n=66)
A5 pocket book 25 22 1
48 (73%)
Copy on intranet 9 -
18 (27%)

12. Do you have your own copy of the guidelines?84 29
Response
Medical Staff
(n=25)
Nursing Staff
(n=31)
Other
(n=1)
Total (%)
(n=57)
Yes 21 9 -
30 (53%) No 4 22 1
27 (47%)

13. Who provided you with a copy of the guidelines?
Came in post 1
Clinical Risk Manager
College Tutor 3
Guideline Lead at UHNS
Lynne Lovekin, Rota Co-ordinator at UHNS 11
Maternity Unit, Shrewsbury
Network 2
Trudie Roberts
Trust

14. When at work, do you keep your copy of the guidelines with you?24 22 52 33 44 24
Response
Medical Staff
(n=21)
Nursing Staff
(n=9)
Other
(n=0)
Total (%)
(n=30)
Yes, all the time 5 4 -
9 (30%)
Yes, some of the time 11 3
14 (47%)
No, never 2
7 (23%)

15. How often do you refer to the guidelines?16 19
100 52 52 32 22 7
Response
Medical Staff
(n=25)
Nursing Staff
(n=27)
Other
(n=1)
Total (%)
(n=53)
Daily - 2 1
3 (6%)
Once a week 8 6
14 (26%)
Once a month 13 14
27 (51%)
Never 4 5
9 (17%)

16. How easy / difficult do you find the guidelines to use?12 96 60
100 28 4
Response
Medical Staff
(n=25)
Nursing Staff
Other
(n=1)
Total (%)
(n=51)
Very easy 1 7 -
8 (16%)
Easy 24 15
40 (78%)
Difficult 3
3 (6%)
Very difficult

17. How easy / difficult do you find the index to use to find
How easy / difficult do you find the index to use to find the information you require in the guidelines? 4 13 80 71
100 16 17
Response
Medical Staff
(n=25)
Nursing Staff
(n=24)
Other
(n=1)
Total (%)
(n=50)
Very easy 4 -
8 (16%)
Easy 20 17 1
38 (76%)
Difficult 3
4 (8%)
Very difficult

18. What do you think about the quantity of information in the guidelines?92 83
100 13
Response
Medical Staff
(n=25)
Nursing Staff
(n=24)
Other
(n=1)
Total (%)
(n=50)
Too detailed - 3
3 (6%)
Right amount of detail 23 20 1
44 (88%)
Not enough detail 2

19. How easy / difficult to follow do you find the text in the guidelines?8 13 84 75
100 13 8
Response
Medical Staff
(n=25)
Nursing Staff
(n=24)
Other
(n=1)
Total (%)
(n=50)
Very easy 2 3 -
5 (10%)
Easy 21 18 1
40 (80%)
Difficult
Very difficult

20. How clear / difficult to follow do you find the diagrams in the guidelines?13 92 75
100 8 13
Response
Medical Staff
(n=25)
Nursing Staff
(n=24)
Other
(n=1)
Total (%)
(n=50)
Very easy 2 3 -
5 (10%)
Easy 23 18 1
42 (84%)
Difficult
5 (6%)
Very difficult

21. In which format would you prefer the guidelines to be available in?9 21 16 25 19 4
100 56 50
Response
Medical Staff
(n=28)
Nursing Staff
(n=32)
Other
(n=1)
Total (%)
(n=61)
A5 pocket book 14 18 1
33 (54%)
A4 folder in clinical area 6 -
7 (11%)
Copy on intranet 7 5
12 (20%)
All formats 3
9 (15%)

22. Conclusions 92% are aware of the Obstetric guidelines
85% have seen a copy of the Obstetric guidelines
73% A5 pocket book, 27% copy on the intranet
84% of medical staff own a copy of the guidelines, compared to 29% of nursing staff
30% keep their copy with them at all times, compared to 47% some of the time

23. Conclusions
88% felt the guidelines contained the right amount of detail
76% found the index easy to use
80% found the text easy to follow
84% found the diagrams easy to follow
78% found the guidelines as a whole easy to use 23

24. Conclusions
51% refer to the guidelines once a month, compared to 26% once a week, and 6% daily
All members of staff preferred the A5 pocket book (54% total)
However more nursing staff (19%) preferred to have the guidelines as an A4 folder, compared to medical staff (4%)

25. Conclusions
Improved feedback from Mid Staffordshire General Hospital and Dudley Group of Hospitals
Reasons why some trusts use the guidelines more than others
Promotion and increased awareness in trusts
More numbers, greater feedback 25

26. Action to be completed by
Action Plan
Action
Co-ordinator
Action to be completed by
The results and comments of the audit will be used in the development of the next edition of the Obstetric Guidelines
Obstetric Guideline Group
Feb 2012
The results and comments will be used to influence any future decision as to how the guidelines will be distributed within the Network
Allow increased accessibility of the A5 pocket book to nursing staff
The possibility of producing an A4 version of the guidelines will be discussed