gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Reasons for rapid implementation of antenatal magnesium guidelines for neuroprotection

Meeting Abstract

  • P. Middleton - ARCH, Robinson Institute, The University of Adelaide, Adelaide, Australia
  • C. Crowther - ARCH, Robinson Institute, The University of Adelaide, Adelaide, Australia
  • P. Ashwood - ARCH, Robinson Institute, The University of Adelaide, Adelaide, Australia
  • S. Reid - ARCH, Robinson Institute, The University of Adelaide, Adelaide, Australia
  • T. Bubner - ARCH, Robinson Institute, The University of Adelaide, Adelaide, Australia
  • E. Bain - ARCH, Robinson Institute, The University of Adelaide, Adelaide, Australia
  • E. Heatley - ARCH, Robinson Institute, The University of Adelaide, Adelaide, Australia
  • S. McIntyre - Cerebral Palsy Institute, University of Notre Dame Australia, Sydney, Australia
  • J. Morris - Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
  • V. Flenady - Mater Medical Research Institute, Brisbane, Australia

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocO35

DOI: 10.3205/12gin067, URN: urn:nbn:de:0183-12gin0676

Published: July 10, 2012

© 2012 Middleton et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Introduction: Within two years of dissemination of clinical practice guidelines, antenatal magnesium sulphate for protecting preterm babies’ brains is now given to 70-80% of eligible mothers giving birth in a number of Australian tertiary maternity hospitals in Australia, a fourfold increase.

Objective: To assess which dissemination activities and parts of the bi-national WISH implementation program are influencing magnesium uptake, using a behavioural change theory. This has three main components – capability, motivation and opportunity (Michie et al Implementation Science. 2011 Apr 23;6:42).

Methods: Since 2010 we have tracked clinicians’ knowledge, attitudes and activities regarding antenatal magnesium sulphate; and sentinel dissemination and implementation events. We are auditing antenatal use of magnesium sulphate, allowing us to explore which behavioural changes may be driving rapid and substantial rises in uptake.

Results:

  • Capability (physical and psychological) is high with positive attitudes to guidelines and awareness through dissemination and education of an already skilled workforce.
  • Reflective motivation is also generally high except for a few sceptical clinicians (who however may be responding to automatic processes of motivation such as persuasion by other colleagues, as well as concern that children not receiving antenatal magnesium may subsequently be diagnosed with cerebral palsy).
  • The WISH study/program is enhancing opportunity (both physical and social) by establishing and supporting implementation teams in hospitals, providing resources such as reminder flags, and through audit and feedback.

Conclusions: Degree of antenatal magnesium uptake can potentially be explained using Michie’s behaviour change wheel, although it could be refined to better accommodate more clinically based interventions.