Fidelity of an Implementation Strategy for a Maternal Early Warning System Protocol at a Tertiary Care Centre

Maternal Early Warning System (MEWS) protocols are promising clinical tools to enhance maternal care for acute conditions. Effective implementation of new evidence-based practices relies on implementation strategy fidelity (i.e., the degree to which the implementation strategy is delivered as intended). Thus, we evaluated the fidelity of the implementation strategy for the MEWS protocol, with a focus on educational activities.

This cross-sectional evaluation was part of a quality improvement initiative. We used a fidelity framework assessing adherence (alignment with design), dose (amount/intensity), and participant responsiveness (engagement and adoption) to the implementation strategy. Results were summarized with descriptive statistics and content analysis.

Within the implementation strategy, 20 out of 21 planned educational activities (multidisciplinary simulations, skills drills) and departmental Grand Rounds were completed. These activities recorded 246 attendances (137 among nurses, 40 among residents, 36 among physicians, and 33 among allied health professionals). In a post-session survey completed by 76 participants following educational activities, 52.6% (n = 40/76) and 43.4% (n = 33/76) of participants reported feeling "extremely comfortable" escalating care and activating a Code Blue, respectively. Qualitative feedback from 23 respondents identified benefits in autonomy/confidence (n = 9), safety (n = 6), communication (n = 3), and teamwork (n = 3), while emphasizing patient-centred care (n = 6) in emergency situations.

Most sessions were completed as intended and led to high participant engagement. Responsiveness results suggest that the implementation strategy prepared health care providers for uptake of the MEWS protocol and supported them in carrying out patient-centred assessments, while maximizing professional autonomy/collaboration and optimizing equitable care delivery.