Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation Process Theory.
<h4>Background</h4>Post-partum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. The Obstetric Bleeding Strategy (OBS) care bundle for PPH management was adopted into Welsh national guidelines in 2019 (as OBS Cymru), and is currently being impl...
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Public Library of Science (PLoS)
2025-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0320754 |
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| author | Tanvi Rai Lisa E Hinton Rosa Mackay Mairead Black Julia Sanders Pauline Slade Amy Elsmore Amrit Dhadda William Parry-Smith Rachel Collis Stavros Petrou Simon Stanworth Philip Pallman Julia Townson Haddy Fye Ayşe Gür Geden Peter Collins Sarah Bell |
| author_facet | Tanvi Rai Lisa E Hinton Rosa Mackay Mairead Black Julia Sanders Pauline Slade Amy Elsmore Amrit Dhadda William Parry-Smith Rachel Collis Stavros Petrou Simon Stanworth Philip Pallman Julia Townson Haddy Fye Ayşe Gür Geden Peter Collins Sarah Bell |
| author_sort | Tanvi Rai |
| collection | DOAJ |
| description | <h4>Background</h4>Post-partum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. The Obstetric Bleeding Strategy (OBS) care bundle for PPH management was adopted into Welsh national guidelines in 2019 (as OBS Cymru), and is currently being implemented across 36 sites in the rest of the UK through the OBS UK stepped-wedge cluster randomised controlled trial. We conducted a qualitative evaluation of the OBS care bundle five years after its adoption to inform plans for optimising its implementation across the UK.<h4>Methods</h4>We conducted ethnographic observations, informal conversations and qualitative interviews with multidisciplinary teams (MDT) in four maternity units in Wales. Data were analysed thematically and using Normalisation Process Theory.<h4>Results</h4>The OBS Cymru protocol was used daily and MDT members believe it improves the quality and safety of PPH management. The paper proforma supporting OBS Cymru was the 'boundary object' that kept the care bundle in view while clarifying individualised roles across the MDT during a PPH and prompting improved and continuous communication as bleeding progressed. The standardisation of processes through the care bundle was seen as enabling all staff with an overall knowledge of PPH care, while situating the prominence of their particular roles within a greater whole. Enacting the bundle in practice varied slightly across different settings, according to staffing structures (e.g., in delivery rooms versus theatre births) and caseload, and some residual tensions remained regarding expectations from different staff members and levels of support provided regarding OBS Cymru.<h4>Conclusions</h4>Despite some small-scale variations, OBS care bundle has become normalised as standard PPH care in Wales. Insights from this evaluation, such as the centrality of the proforma in holding the bundle together, and need for greater clarity in staff role expectations, have informed implementation plans for the OBS UK trial. |
| format | Article |
| id | doaj-art-73906fe3672645388bdcf181c1bdc4d3 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj-art-73906fe3672645388bdcf181c1bdc4d32025-08-20T03:11:52ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01204e032075410.1371/journal.pone.0320754Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation Process Theory.Tanvi RaiLisa E HintonRosa MackayMairead BlackJulia SandersPauline SladeAmy ElsmoreAmrit DhaddaWilliam Parry-SmithRachel CollisStavros PetrouSimon StanworthPhilip PallmanJulia TownsonHaddy FyeAyşe Gür GedenPeter CollinsSarah Bell<h4>Background</h4>Post-partum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. The Obstetric Bleeding Strategy (OBS) care bundle for PPH management was adopted into Welsh national guidelines in 2019 (as OBS Cymru), and is currently being implemented across 36 sites in the rest of the UK through the OBS UK stepped-wedge cluster randomised controlled trial. We conducted a qualitative evaluation of the OBS care bundle five years after its adoption to inform plans for optimising its implementation across the UK.<h4>Methods</h4>We conducted ethnographic observations, informal conversations and qualitative interviews with multidisciplinary teams (MDT) in four maternity units in Wales. Data were analysed thematically and using Normalisation Process Theory.<h4>Results</h4>The OBS Cymru protocol was used daily and MDT members believe it improves the quality and safety of PPH management. The paper proforma supporting OBS Cymru was the 'boundary object' that kept the care bundle in view while clarifying individualised roles across the MDT during a PPH and prompting improved and continuous communication as bleeding progressed. The standardisation of processes through the care bundle was seen as enabling all staff with an overall knowledge of PPH care, while situating the prominence of their particular roles within a greater whole. Enacting the bundle in practice varied slightly across different settings, according to staffing structures (e.g., in delivery rooms versus theatre births) and caseload, and some residual tensions remained regarding expectations from different staff members and levels of support provided regarding OBS Cymru.<h4>Conclusions</h4>Despite some small-scale variations, OBS care bundle has become normalised as standard PPH care in Wales. Insights from this evaluation, such as the centrality of the proforma in holding the bundle together, and need for greater clarity in staff role expectations, have informed implementation plans for the OBS UK trial.https://doi.org/10.1371/journal.pone.0320754 |
| spellingShingle | Tanvi Rai Lisa E Hinton Rosa Mackay Mairead Black Julia Sanders Pauline Slade Amy Elsmore Amrit Dhadda William Parry-Smith Rachel Collis Stavros Petrou Simon Stanworth Philip Pallman Julia Townson Haddy Fye Ayşe Gür Geden Peter Collins Sarah Bell Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation Process Theory. PLoS ONE |
| title | Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation Process Theory. |
| title_full | Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation Process Theory. |
| title_fullStr | Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation Process Theory. |
| title_full_unstemmed | Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation Process Theory. |
| title_short | Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation Process Theory. |
| title_sort | managing obstetric bleeding in wales a qualitative evaluation of the obs cymru care bundle using normalisation process theory |
| url | https://doi.org/10.1371/journal.pone.0320754 |
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