Background Birth related perineal trauma can have a major impact on women’s health. The correct assessment and repair of perineal injuries are procedures that require knowledge and skill. Currently, there is no agreement as to what constitutes an effective training programme. We produced and tested an interactive distance learning multi-professional training package called ePEARLS. This was developed as a tool for the delivery and assessment of perineal repair training in line with UK evidence based practise. Methods The main aim of this project was to develop, refine and assess ePEARLS as a tool for the assimilation of knowledge and skill to clinicians involved in Intrapartum care. Using pre and post-training objective assessments for both knowledge and skill, we compared the effect of delivering training using ePEARLS compared to other training models in three independent multi-professional groups from three different maternity units. Results Thirty-eight participants were involved in the study. Improvements in knowledge scores were marginally significant in all three groups. However, more marked improvements in skill scores were noted in response to the different training models. Conclusion ePEARLS is the first multi-professional interactive perineal trauma management e-learning package that has been formally tested against other training models. The potential cost effectiveness of this package makes it far superior to other methods of delivering training and maintaining competency.
Background Birth associated perineal trauma affects millions of women worldwide. The aim of the Perineal Assessment and Repair Longitudinal Study (PEARLS) was to evaluate if an enhanced, cascaded training programme improved implementation of evidence-based practise in perineal assessment and repair and reduced subsequent maternal morbidity. Methods PEARLS was a pragmatic matched pair cluster randomised controlled trial with 22 participating UK maternity units. Within each of the 11 matched pairs one unit was randomised to receive the intervention early (cluster A) and the other late (cluster B). Women sustaining a second-degree tear or episiotomy were eligible. Outcomes included pain on activity at 10–12 days postnatal, clinically reported outcomes by women and implementation of evidence-based surgical repair. Analysis was based on summary statistics at cluster level, using paired t-tests. Results 1470 and 2211 women were recruited in groups A and B respectively. No significant difference in mean primary outcome was noted between clusters that had received the intervention and those who had not (0.7% 95% CI (–10.1%, 11.4%), p = 0.89), with the overall percentage of women being 77% and 74% respectively. Improvement was seen in implementation of evidence-based perineal management. A significant reduction was noted in mean percentages of women reporting wound infections and needing suture removal in the early intervention clusters. Conclusion PEARLS is the first RCT to assess the impact of a ‘hands-on’ training package on implementation of evidence-based perineal trauma management and clinical outcomes for women. Findings will support improvements in clinical practise and women’s longer-term health.
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