The OASI Care Bundle Project

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.
 

Update

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.

Background

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.

Aim

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

Methods

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 on the development of the project, please visit the background page
• For answers to frequently asked questions, please visit the FAQ page
• For information about the Lindsay Stewart Centre for Audit and Clinical Informatics, please visit the main audit and clinical improvement page
• Find out more information about The Health Foundation and the Scaling Up Programme
• Read news articles about the OASI Care Bundle project:
  • RCM and RCOG announce the launch of the OASI Care Bundle Quality Improvement Project – RCM.org.uk
  • Perineal protection: it's in your hands – Midwives Magazine
  • Perineal trauma: the power of partnership – Midwives Magazine
  • OASI Project in O&G Magazine Spring 2017
  • BBC News video: “The hidden trauma of being torn during childbirth”
• Follow and tweet on Twitter using the hashtag #oasicarebundle
• The MASIC Foundation provides support for women affected by OASI
• Download our OASI flyer (PDF 207kb)

Contact us

For more information about the OASI care bundle Scaling Up Programme, please email OASICareBundle@rcog.org.uk or call +44 20 7772 6347.