Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in CanadaReport as inadecuate




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BMC Pregnancy and Childbirth

, 15:347

First Online: 22 December 2015Received: 30 April 2015Accepted: 10 December 2015

Abstract

BackgroundAdministration of magnesium sulphate MgSO4 to women with imminent preterm birth at <34 weeks is an evidence-based antenatal neuroprotective strategy to prevent cerebral palsy. Although a Society of Obstetricians and Gynaecologists of Canada SOGC national guideline with practice recommendations based on relevant clinical evidence exists, ongoing controversies about aspects of this treatment remain. Given this, we anticipated managed knowledge translation KT would be needed to facilitate uptake of the guidelines into practice. As part of the Canadian Institutes of Health Research CIHR-funded MAG-CP MAGnesium sulphate to prevent Cerebral Palsy project, we aimed to compare three KT methods designed to impact both individual health care providers and the organizational systems in which they work.

MethodsThe KT methods undertaken were an interactive online e-learning module available to all SOGC members, and at MAG-CP participating sites, on-site educational rounds and focus group discussions, and circulation of an anonymous ‘Barriers and Facilitators’ survey for the systematic identification of facilitators and barriers for uptake of practice change. We compared these strategies according to: i breadth of respondents reached; ii rates and richness of identified barriers, facilitators, and knowledge needed; and iii cost.

ResultsNo individual KT method was superior to the others by all criteria, and in combination, they provided richer information than any individual method. The e-learning module reached the most diverse audience of health care providers, the site visits provided opportunity for iterative dialogue, and the survey was the least expensive. Although the site visits provided the most detailed information around individual and organizational barriers, the ‘Barriers and Facilitators’ survey provided more detail regarding social-level barriers. The facilitators identified varied by KT method. The type of knowledge needed was further defined by the e-learning module and surveys.

ConclusionsOur findings suggest that a multifaceted approach to KT is optimal for translating national obstetric guidelines into clinical practice. As audit and feedback are essential parts of the process by which evidence to practice gaps are closed, MAG-CP is continuing the iterative KT process described in this paper concurrent with tracking of MgSO4 use for fetal neuroprotection and maternal and child outcomes until September 2015; results are anticipated in 2016.

KeywordsKnowledge translation Magnesium sulphate Fetal neuroprotection Preterm birth AbbreviationsACOGAmerican College of Obstetricians and Gynecologists

BandFbarriers and facilitators

BCBritish Columbia

BCWHBritish Columbia Women’s’ Hospital and Health Centre

CIHRCanadian Institutes of Health Research

CNFUNCanadian Neonatal Follow-up Network

COREQconsolidated criteria for reporting qualitative research

CPCerebral Palsy

CPNCanadian Perinatal Network

HDPhypertensive disorder of pregnancy

KTknowledge translation

MAG-CPmagnesium sulphate for fetal neuroprotection of the preterm infant

MDMedical Doctor

MgSO4Magnesium Sulphate

RCTrandomized controlled trials

RNregistered nurse

SOGCSociety of Obstetricians and Gynaecologists of Canada

UBCUniversity of British Columbia

Electronic supplementary materialThe online version of this article doi:10.1186-s12884-015-0785-8 contains supplementary material, which is available to authorized users.

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Author: Katherine C. Teela - Dane A. De Silva - Katie Chapman - Anne R. Synnes - Diane Sawchuck - Melanie Basso - Robert M. Lis

Source: https://link.springer.com/







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