This scaling up programme is a collaboration between the RCOG, Croydon Health Services NHS Trust, the Royal College of Midwives (RCM) and the London School of Hygiene and Tropical Medicine (LSHTM), with funding provided by The Health Foundation.
Formal implementation of the care bundle in the 16 participating units has ended and the project team are now evaluating the care bundle. Read the study protocol for the project.
In the past 10 years, rates of Obstetric Anal Sphincter Injury (OASI) have increased in England. Experiences in some maternity units have shown that some of the underlying problems related to this rise in OASI include:
- Inconsistencies in approaches to preventing OASIs
- Inconsistencies in training and skills
- Lack of awareness of risk factors and long-term impact of OASIs
- Variation in practice between health professionals
In light of this, the OASI care bundle team have developed and piloted an intervention package, including a care bundle and guide, a multidisciplinary skills development module for health care professionals, and campaign materials (such as leaflets and newsletters designed to raise awareness). The OASI Care Bundle Project received funding from the Health Foundation Scaling Up Programme to implement this intervention in 16 maternity units across England, Scotland and Wales.
To reduce overall OASI rates through an increase in the use of standardised prevention practice.
Watch: The project team on scaling up the OASI Care Bundle Quality Improvement Project
Recruitment of the sites is complete, with both a Midwifery and an Obstetric Champion volunteering to lead the programme from within each hospital. Support from local clinical champions, opinion leaders and professional organisations, as well as patient and public involvement and continuous monitoring and feedback, will help ensure that interventions are acceptable to women and health care professionals.
The programme has run for 2.5 years. The evaluation of the programme includes evaluation of the impact of the OASI care bundle on clinical practice and clinical outcomes. Results will be shared through publications.
This project focuses on OASI resulting from labour and vaginal birth. The project excludes the management and prevention of OASI resulting from gynaecological/urological procedures. It also excludes considerations on repair techniques and related co-morbidities.
Evidence for the project
- Carrol F, Knight H, Cromwell DA, Gurol Urganci I, van der Meulen J. Patterns of maternity care in English NHS trusts 2013/2014; 2016.
- Gurol-Urganci I, Cromwell DA, Edozien LC, Mahmood TA, Adams EJ, Richmond DH, et al. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors.BJOG 2013;120:1516–25.
Find out more
For more information about the OASI care bundle Scaling Up Programme, please email OASICareBundle@rcog.org.uk or call +44 20 7772 6347.