A document analysis of clinical guidelines for the paramedic management of obstetric and neonatal presentations in Australian and New Zealand ambulance services

Belinda Flanagan, Nigel Barr, James Pearce, Kathryn Eastwood
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Abstract

Paramedics receive varying levels of training in obstetric presentations. In high-risk, low-frequency cases, clinical guidelines should support clinicians to deliver optimal care. This study analysed publicly available clinical guidelines for obstetric presentations published by ambulance services in Australia and Aotearoa New Zealand to determine consistency of clinical guidance and adherence to nationally recognised standards for the development and reporting of evidence-based guidelines. Guidelines were sourced from publicly available websites of Australian and Aotearoa New Zealand ambulance services. The text was imported into a custom data collection frame which focused on five predefined specific obstetric presentations. Data were extracted and measured against nationally and internationally recognised best practice standards. Nine independent sets of clinical guidelines were included in the analysis. There was wide variation in the clinical guidance provided and scope of practice. Aspects were found to be absent, inconsistent, not supported by evidence or having potential to cause harm. None were consistent with recognised Australian best practice standards for guideline development in the areas of referencing and grading of evidence. This study found substantial inconsistency of clinical guidance, highlighted conflicting and inadequate advice, and assessed the safety of advice provided when compared to best practice standards and evidence-based recommendations. Sustained effort to improve ambulance service clinical guidance regarding obstetric presentations is warranted.
对澳大利亚和新西兰救护车服务中辅助医务人员处理产科和新生儿病例临床指南的文件分析
辅助医务人员在产科病例方面接受过不同程度的培训。对于高风险、低频率的病例,临床指南应支持临床医生提供最佳护理。本研究分析了澳大利亚和新西兰奥特亚罗瓦救护服务机构发布的公开产科临床指南,以确定临床指南的一致性,以及是否符合国家认可的循证指南制定和报告标准。指南来自澳大利亚和新西兰奥特亚罗瓦救护服务机构的公开网站。文本被导入到一个自定义的数据收集框架中,该框架主要针对五种预定义的特定产科病症。根据国内和国际公认的最佳实践标准提取和衡量数据。分析包括九套独立的临床指南。所提供的临床指南和实践范围差异很大。有些方面被认为不存在、不一致、没有证据支持或可能造成伤害。在参考文献和证据分级方面,没有一项符合澳大利亚公认的指南制定最佳实践标准。本研究发现临床指南存在严重的不一致性,强调了存在冲突和不足的建议,并根据最佳实践标准和循证建议对所提供建议的安全性进行了评估。有必要继续努力,改进救护车服务对产科病例的临床指导。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
1.30
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0.00%
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