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References

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2. Aghlmand S, Akbari F, Lameei A, Mohammad K, Small R, Arab M. Developing evidence-based maternity care in Iran: a quality improvement study. BMC Pregnancy Childbirth. 2008 Jun 13;8:20

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Development of a clinical pathway for normal vaginal delivery in Emam Reza hospital in Urmia

Lameei A¹. Mosafer Yadegari A^2*. Nasiripour AA³. Maleki MR⁴

Submitted: 21.9.2011 Accepted: 30.11.2011

Abstract

Background: Since normal vaginal delivery is concerned in the mother’s health and their child, different levels of the healthcare system are engaged in this process, and due to the high rates of studies related to normal vaginal delivery is one of the priority areas in medical research worldwide. Function of normal vaginal delivery process- like many other clinical processes- is far from optimal in Emma Reza hospital, and needs improvement. This study was carried out with the aim of development of a clinical pathway for normal vaginal delivery to improve this process. In this paper we report the process of clinical pathway development. We will report the results of its implementation later.

Materials & Methods: This is a quality improvement study which is one of the effectiveness or online studies. In this study we used Dr. Lameei's model for clinical pathway development. The following activities were done for the pathway development: 1) the quality improvement steering committee of the hospital took the responsibility of the overseeing the clinical pathway development process and policy issues in the hospital. 2) The steering committee created the criteria for selection of the first clinical process for pathway development. 3) Based on the criteria, the normal vaginal delivery process was selected for clinical pathway development. 4) Flow chart of the process was depicted and a multidisciplinary team was formed. 5) The multidisciplinary team assessed the current function of the process. 6) Using methods of evidence-based medicine, the team found out the best practice regarding normal vaginal delivery. 7) The team determined the format and content of the pathway. 8) It created a list of possible variances from the pathway. 9) Finally, the team developed the standing orders and necessary evidence based protocols.

Results: The outputs of the pathway development stage of this study were: 1) normal vaginal delivery clinical pathway. 2) Inclusion criteria into the pathway. 3) List of the variances. 4) Evidence based actions regarding each variance, standing orders, and necessary protocols.

Conclusion: Clinical pathway was an effective tool for designing and standardization of clinical processes based on evidence based medicine. Nine steps model (FOCUS-PDCA) which used in this study was performable. The pathway development took more about one and half years, which was longer than the time western countries have used to develop clinical pathways. Two outstanding constraints in affecting the time devoted for clinical pathway development were: 1) Non familiarity of the multidisciplinary team with the concepts and principals of the clinical processes quality improvement in general, and the clinical pathway development in particular. 2) It took a very long time for the team to go through the team development stages and becoming a mature performing team.

Keywords: Normal vaginal delivery, Clinical pathway, EMAM REZA hospital

1. Invited Professor, Department of Health Services Management, Science and Research Branch, Islamic Azad University, Tehran, Iran.

2. PH.D Student in Health Services Management, Department of Health Services Management, Science and Research Branch, Islamic Azad University, Tehran, Iran. (* Corresponding Author): Abdollah Mosafer Yadegari, Health Management of Social Security Organisation, Kashani Street, Urmia, West Azarbaijan. [email protected]. 09143430659 3. Associated Professor, Department of Health Services Management, Science and Research Branch, Islamic Azad University,

Tehran, Iran.

4. Associated Professor, Department of Health Services Management, Tehran Medical University, Tehran, Iran.