Service‐wide management of healthy gestational weight gain following an implementation science approach

Abstract

The aim of health guidelines is to ensure consistency in the delivery of care to minimise health-related complications. However, even when good evidence is available, professionals do not necessarily implement it. Following a 2011 survey (Time 1) of staff in a tertiary maternity hospital, a number of service changes were implemented to facilitate best practice delivery of care to pregnant women regarding gestational weight gain (GWG). A (second) staff survey was then undertaken to re-assess staff knowledge, attitudes and behaviours around the management of GWG in our hospital. This cross-sectional, prospective online survey was distributed to staff in antenatal clinic. The survey assessed staff awareness of pregnancy-related weight complications, knowledge and application of specific guidelines, and a guideline adherence score was calculated. Sixty-nine staff (44.8% response rate) completed the 2014 (Time 2) survey. Just over half (51.9%) stated they were familiar with clinical guidelines regarding weight management in pregnancy. Guideline adherence ranged from 3.7 ± 1.9 to 11.3 ± 1.0 /15 across different professional groups; significant improvements with adherence by dietitians were noted over time. Despite minimal change over time in the overall adherence score, compliance with individual elements of the guideline recommendations comprising the adherence score differed. Improvements in staff practices and attitudes are apparent since the first survey. However, further improvements in guideline awareness and guideline elements are still required to improve the delivery of best practice antenatal GWG care.

Impact of service‐wide initiatives to support healthy pregnancy weight gain on weight‐related documentation

“…Two recent papers from the same institution used an implementation science approach to address identified barriers to GWG guideline adherence and weight documentation . These studies demonstrated that increased knowledge (staff education), capabilities (scales in each clinic room) and reliance on memory (electronic prompting to record weight) significantly improved documentation .…”

Re‐evaluating the nutritional awareness, knowledge and eating behaviours of women attending a tertiary maternity hospital following iterative service redesign

“…It has been clearly demonstrated that interventions which include dietary advice, and physical activity, supported by ongoing weight monitoring can prevent excessive GWG and result in more women across all BMI categories achieving weight gain within correct ranges . It may be suggested that this increase in appropriate GWG is a result of service wide changes and support, including guidance provided by dietitians …”

“…[50][51][52][53] It may be suggested that this increase in appropriate GWG is a result of service wide changes and support, including guidance provided by dietitians. 31 Study strengths included the use of an implementation science framework (KTA Framework 13 ) to guide service development and evaluation and our use of the same survey for both cohorts. The recruitment method and response rate are both a strength and a limitation.…”

“…The progressively evolving MMH nutrition and dietetic service has included a series of strategies and initiatives implemented and refined since 2008. These have included: Improved promotion of the dietetic services and education around nutrition issues facing pregnant women to hospital staff and general practitioners who share maternity care with the MMH (commenced 2008) A new nutrition in pregnancy booklet for midwives to distribute to all women at first booking visit (‘Healthy eating during pregnancy’, commenced 2008) An early pregnancy nutrition education workshop for patients (‘Healthy Start to Pregnancy’ (HSP) workshop) (from 2011 initially as an evening group then from 2013 delivered within antenatal clinic, most days of the week) An outpatient postnatal program to support women's awareness of and ability to adopt healthy postnatal nutrition behaviours, ‘Nutrition for New Mums’ (commenced 2012) The translation of GDM nutrition practice guidelines into the antenatal clinic (from 2012) Integration of the dietitian into the antenatal clinic on each day of the week, providing one on one appointments and the HSP group education sessions (from 2014) A service‐wide implementation of GWG guidelines via addressing evidence‐practice gaps in staff knowledge and including staff training, scale placement in every room and a change to weight recording practice in the hospital's maternity database ‘Matrix’ (from 2014) An integration of GWG management tool ‘The Personalised Pregnancy Weight Tracker’ (from 2008) The development and implementation of ‘Nine months of nutrition’ resource as part of the addition to the suite of education and communication methods (from 2014) which is a series of seven web‐based and USB‐delivered, voice‐over PowerPoint presentations disseminated via television screens throughout the MMH clinic waiting areas and also hosted on the hospital's website …”

Preventing large birth size in women with preexisting diabetes mellitus: The benefit of appropriate gestational weight gain

“…We have limited population-level estimates on how much information patients receive from clinicians regarding GWG using the most recent IOM guidelines. However, recent research has shown that improving clinician knowledge and effort to address appropriate GWG has been effective in helping women gain within IOM recommendations (Lindberg et al, 2016; Wilkinson et al, 2016). In addition, strategies such as meeting dietary and physical activity goals have been shown to help women gain within IOM recommendations (Muktabhant et al, 2015).…”