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Enhancing evidence-based practices and person-centered care during induction of labor: Insights from a quality
Mohamed Rishard1,2, Hasna Riyal1, Indu Asanka Jayawardane1,2
1Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Background:
Induction of labor without indications is a growing concern in obstetric care, particularly in low- and middle-income countries (LMIC). This practice not only increases the risk of unnecessary medical interventions but also places undue stress on healthcare systems and patients. This study evaluated the outcomes of a quality improvement (QI) initiative aimed at enhancing evidence-based practices and person-centered care during induction of labor (IOL) in a low-resource setting.
Methods:
The QI initiative was conducted at a tertiary care hospital in Sri Lanka from January 2019 to December 2022 and comprised four phases: retrospective audit, co-creation of interventions, implementation, and re-audit. The interventions included training healthcare providers, developing unit protocols, implementing patient safety checklists, and providing patient information leaflets.
Results:
The baseline audit revealed suboptimal adherence to evidence-based practices and inadequate patient involvement in decision-making. Following the intervention, improvements were observed in documenting the indications for IOL (59% to 90%), obtaining informed consent (2% to 91%), conducting pre-induction assessments (30.8% to 100%), and using Foley catheters during induction (39% to 68%). However, an increase in caesarean section rates was noted (22.3% to 35.4%), possibly because of factors such as staff shortages, limited drug availability, and increased maternal obesity during the post-intervention period. Neonatal outcomes, including admission to special care units and intrapartum death rates, have also improved.
Conclusion:
This study highlights the importance of standardized induction protocols and continuous monitoring to sustain and enhance the quality of maternal care in LMIC. Further research is needed to explore the reasons for the increased caesarean section rates and develop targeted strategies to reduce unnecessary interventions while maintaining high-quality care.
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