Effect of Implementing Clinical Pathway to Improve Child-Birth and Neonatal Outcomes

Abstract

Background: A clinical pathway is a multidisciplinary management tool based on evidence-based practice for a specific group of patients with a predictable clinical course, in which the different tasks "interventions" by the professionals involved in the patient care are defined, optimized and sequenced either by hour, day or visit. The aim of the present study was to examine the effect of implementing clinical Pathway to improve birth and neonatal outcomes. Design: Quasi-experimental study was used. Settings: this study was conducted at Maternal and child health center and labor unit of El-Basher Hospital /Amman Jordon. Subjects: The simple random sample of 150 mothers were selected and divided into equal group; intervention group (75 mothers who received clinical pathway during third trimester of pregnancy and/or labor) and control group 75 mothers who not received clinical pathway. Pregnant mothers were selected between 28-36 week antenatal visit, observed, and followed during labor for the use of pathway. Results of the study: revealed that there was significance difference between intervention and control groups concerning implementation of clinical pathway through application of "counting fetal movement and implementation of comfort measures", throughout the third trimester of pregnancy, labor process, that affect the progress and effect in reducing the severity of labor pain. There were significant differences among two studied group regarding pain intensity in relation to cervical dilatation CX 3-4 cm (11.570, 0.054* respectively), CX 5-7cm (13.348, 0.013* respectively) and CX 8-10 cm (12.671, 0.015* respectively). The duration of labor during all stages of labor were significant difference among studied groups (p p th minute and at 10th minute in intervention group were significant higher (6.9±1.1 and 8.8±1.3) than in control group (4.8±0.8 and 7.03±1.5). Conclusions: - The use of clinical care pathways: "counting fetal movement and implementation of comfort measures" for optimizing prenatal care had a positive influence on child birth process and neonatal outcomes in obstetric practice. Recommendations: 1. Application of clinical pathway for pregnant mothers is essential for improving maternal status, reducing complication and reducing the duration of hospital stay and better neonatal outcome. 2. Ongoing in-service training programs should be designed and implemented at delivery room to improve nurses' practices on the basis of nurse's actual needs.