National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism

Associations of exposure to disinfection by-products with blood coagulation parameters among women: Results from the Tongji reproductive and environmental (TREE) study

BACKGROUND

Experimental studies have shown that disinfection byproducts (DBPs) induce coagulotoxicity, but human evidence is scarce.

OBJECTIVE

This study aimed to explore the relationships of DBP exposures with blood coagulation parameters.

METHODS

Among 858 women from the Tongji Reproductive and Environmental (TREE) study, urinary dichloroacetic acid (DCAA) and trichloroacetic acid (TCAA) were detected as internal biomarkers of DBP exposures. We measured activated partial thromboplastin time (APTT), fibrinogen (Fbg), international normalized ratio (INR), prothrombin time (PT), and thrombin time (TT) as blood coagulation parameters. Multivariable linear regression models were utilized to estimate the relationships between urinary DCAA and TCAA and blood coagulation parameters. The effect modifications by demographic and lifestyle characteristics were further explored.

RESULTS

Elevated tertiles of urinary DCAA concentrations were associated with increased PT and INR (11.29%, 95% CI: 1.66%, 20.92% and 0.99%, 95% CI: 0.08%, 1.90% for the third vs. first tertile, respectively; both P for trends < 0.05). Stratification analysis showed that the positive associations were only observed among younger (< 30 years), leaner (body mass index < 24.0 kg/m2), and non-passive smoking women. Moreover, elevated tertiles of urinary TCAA concentrations in positive associations with PT and INR were observed among younger women (17.89%, 95% CI: 2.50%, 33.29% and 1.82%, 95% CI: 0.34%, 3.30% for the third vs. first tertile, respectively; both P for trends < 0.05) but not among older women (both P for interactions < 0.05).

CONCLUSION

Higher levels of urinary DCAA and TCAA are associated with prolonged clotting time among women.

An evaluation of implementation climate in inpatient maternity care: a cross-sectional survey study

OBJECTIVE

Researchers in obstetrics and gynecology are continuously generating new evidence to inform clinical care delivery. Yet, much of this newly emerging evidence fails to be rapidly and effectively integrated into routine clinical practice. Implementation climate refers to clinicians' perceptions of to what degree organizations support and reward use of an evidence-based practice (EBP) and is an important construct in the science of implementation in healthcare. Little is known about implementation climate for EBPs in maternity care. Thus, we aimed to (a) determine the reliability of the Implementation Climate Scale (ICS) for use in inpatient maternity care, (b) describe implementation climate in inpatient maternity care overall, and (c) compare individual perceptions of implementation climate between physician and nursing clinicians on these units.

STUDY DESIGN

We performed a cross-sectional survey of clinicians in inpatient maternity units across 2 urban, academic hospitals in the northeastern United States in 2020. Clinicians completed the 18-question validated ICS [scored 0-4]. Scale reliability by role was evaluated using Cronbach's α. Subscale and total scores were described overall and compared by physician versus nursing role using independent t-tests, as well as linear regression to control for confounders.

RESULTS

111 clinicians completed the survey (physicians = 65; nursing = 46). Physicians were less likely to identify as female (75.4% vs. 100.0%, p < .001), but were of similar age and years of experience as nursing clinicians. Reliability of the ICS was excellent, with Cronbach's α of 0.91 and 0.86 among physicians and nursing clinicians, respectively. Scores were notably low for implementation climate in maternity care overall and for all subscales. ICS total scores were also higher among physicians as compared to nurses (2.18(±0.56) vs. 1.92(±0.50), p = .02), which remained significant in multivariable modeling (p = .02). Unadjusted subscale scores were higher among physicians in Recognition for EBP (2.68(±0.89) vs. 2.30(±0.86), p = .03) and Selection for EBP (2.24(±0.93) vs. 1.62(±1.04), p = .002). After adjustment for potential confounders, subscale scores for Focus on EBP (p = .04) and Selection for EBP (p = .002) were all higher among physicians.

CONCLUSIONS

This study supports the ICS as a reliable scale for measuring implementation climate in the inpatient maternity care setting. Notably lower implementation climate scores across subscales and roles compared to other settings may underlie the vast evidence to practice gap in obstetrics. In order to successfully implement practices that reduce maternal morbidity, we may need to focus on building educational support and rewarding EBP utilization on labor and delivery units, with an emphasis on nursing clinicians.

Patient-reported barriers and facilitators for intermittent pneumatic compression device use on the antepartum unit

OBJECTIVE

To examine patient barriers to intermittent pneumatic compression (IPC) device compliance during antepartum hospital admissions.

METHODS

This was a prospective survey study of a diverse group of pregnant patients who were admitted to the antepartum floor in a quaternary care hospital from June 2019 through March 2021. Patients receiving pharmacotherapy for venous thromboembolism prophylactic or therapeutic indications were excluded. The primary outcome was patient reported barriers to use of IPC during antepartum hospital admission. Responses were summarized using descriptive statistics.

RESULTS

A total of 40 patients were surveyed. All participants correctly identified the purpose of IPC. When asked regarding IPC importance, 7.5% reported not important, 40% reported somewhat important but not a priority, 5% important only on the first day they were given, and 47.5% reported important whenever the patient was in bed. The most bothersome characteristics of IPC use identified by the respondents on a Likert scale from 1 to 5 were sweating, made the legs too hot, restricted movement, and inconvenience and time spent putting on and taking off the IPC. Making the device wireless/cordless (77.5%), using a lighter weight or cooler material for the cuffs (55%), and better availability of nurses to assist with putting on, taking off, and troubleshooting the IPC (17.5%) were identified by patients as ways to increase compliance with IPC.

CONCLUSIONS

This survey identified several modifiable barriers to the use of IPC on the antepartum floor.