TY - JOUR
T1 - Uptake of a guideline for the administration of a rescue course of antenatal corticosteroids
AU - Datkhaeva, Ilina
AU - Dray, Danielle
AU - Has, Phinnara
AU - Stifani, Bianca
AU - Hughes, Brenna L.
AU - Rouse, Dwight J.
N1 - Publisher Copyright:
Copyright © 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017
Y1 - 2017
N2 - OBJECTIVE: To evaluate use (both appropriate and inappropriate) of rescue corticosteroids before and after the implementation of a guideline for their use. METHODS: We conducted a retrospective cohort study using a pharmacy log to identify women who received an initial course of antenatal corticosteroids in the year before (2008) and in the 4 years (2009-2012) after implementation of the guideline. The charts were then reviewed to determine eligibility and assess receipt of rescue corticosteroids according to the guideline. Our primary study outcome was a temporal change in the percentage of appropriate rescue corticosteroid administration. RESULTS: Of 2,528 women who received a first course of corticosteroids, 142 (5.6%) were eligible for a rescue course, of whom 103 (73%) received it. The rate of appropriate administration increased from 18.2% (95% confidence interval [CI] 5-40%) in 2008 to 65.4% (95% CI 44-83%) in 2009, 93.5% (95% CI 79-99%) in 2010, 96.1% (95% CI 80-99%) in 2011, and 75.7% (95% CI 59-88%) in 2012 (P for test of trend <.001). Only 25 of these 103 eligible women (24.3%) delivered within 2-7 days of receipt of the rescue course. The rate of inappropriate administration among women who were not eligible for a rescue course (n=2,381) also rose from 0.4% (95% CI 0.04-1.4%) in 2008 to 1.9% (95% CI 0.9-3.5%) in 2009, 1.8% (95% CI 0.8-3.6%) in 2010, 2.4% (95% CI 1.2-4.3%) in 2011, and 2.2% (95% CI 1.1-4.0%) in 2012 (P for test of trend=.03). Among all recipients of rescue corticosteroids, 28% (41/144) were ineligible according to the guideline. CONCLUSION: Implementation of an institutional guideline for rescue corticosteroids was associated with a high rate of use among eligible women.
AB - OBJECTIVE: To evaluate use (both appropriate and inappropriate) of rescue corticosteroids before and after the implementation of a guideline for their use. METHODS: We conducted a retrospective cohort study using a pharmacy log to identify women who received an initial course of antenatal corticosteroids in the year before (2008) and in the 4 years (2009-2012) after implementation of the guideline. The charts were then reviewed to determine eligibility and assess receipt of rescue corticosteroids according to the guideline. Our primary study outcome was a temporal change in the percentage of appropriate rescue corticosteroid administration. RESULTS: Of 2,528 women who received a first course of corticosteroids, 142 (5.6%) were eligible for a rescue course, of whom 103 (73%) received it. The rate of appropriate administration increased from 18.2% (95% confidence interval [CI] 5-40%) in 2008 to 65.4% (95% CI 44-83%) in 2009, 93.5% (95% CI 79-99%) in 2010, 96.1% (95% CI 80-99%) in 2011, and 75.7% (95% CI 59-88%) in 2012 (P for test of trend <.001). Only 25 of these 103 eligible women (24.3%) delivered within 2-7 days of receipt of the rescue course. The rate of inappropriate administration among women who were not eligible for a rescue course (n=2,381) also rose from 0.4% (95% CI 0.04-1.4%) in 2008 to 1.9% (95% CI 0.9-3.5%) in 2009, 1.8% (95% CI 0.8-3.6%) in 2010, 2.4% (95% CI 1.2-4.3%) in 2011, and 2.2% (95% CI 1.1-4.0%) in 2012 (P for test of trend=.03). Among all recipients of rescue corticosteroids, 28% (41/144) were ineligible according to the guideline. CONCLUSION: Implementation of an institutional guideline for rescue corticosteroids was associated with a high rate of use among eligible women.
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U2 - 10.1097/AOG.0000000000001934
DO - 10.1097/AOG.0000000000001934
M3 - Article
C2 - 28277360
AN - SCOPUS:85014730041
SN - 0029-7844
VL - 129
SP - 720
EP - 726
JO - Obstetrics and gynecology
JF - Obstetrics and gynecology
IS - 4
ER -