Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation...

Area of Science:

• Obstetrics
• Healthcare Implementation Science
• Patient Safety

Background:

• Post-partum haemorrhage (PPH) remains a major global cause of maternal mortality.
• The Obstetric Bleeding Strategy (OBS) care bundle was implemented in Wales in 2019 (OBS Cymru).
• A qualitative evaluation was conducted five years post-adoption to optimize UK-wide implementation.

Purpose of the Study:

• To qualitatively evaluate the implementation and normalization of the OBS care bundle in Welsh maternity units.
• To identify facilitators and barriers to OBS bundle use.
• To inform the optimization of OBS implementation across the UK.

Main Methods:

• Ethnographic observations and qualitative interviews with multidisciplinary teams (MDT) in four Welsh maternity units.
• Thematic analysis supported by Normalisation Process Theory.
• Evaluation of a care bundle five years after adoption.

Main Results:

• The OBS Cymru protocol is used daily, with MDT members reporting improved PPH management quality and safety.
• The supporting proforma acted as a 'boundary object,' clarifying roles and enhancing communication during PPH events.
• Standardization fostered shared PPH knowledge, though minor variations in practice existed due to staffing and caseload.

Conclusions:

• The OBS care bundle has become normalized as standard PPH care in Wales, despite minor variations.
• The proforma's centrality and the need for clearer staff role expectations were key insights.
• Findings inform implementation strategies for the ongoing OBS UK trial.