Bidwell P, Thakar R, Sevadlis N A multi-centre quality improvement project to reduce the incidence of obstetric anal sphincter injury (OASI): Study Protocol. BMC Pregnancy Childbirth. 2018; 18:(1)

Gurol-Urganci I, Cromwell DA, Edozien LC Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG. 2013; 120:(12)1516-25

Implementing quality improvement

02 January 2019
Volume 27 · Issue 1


Service audits are an essential way of identifying areas for development and putting changes into practice. Louise Silverton identifies the essential factors for service improvement

Audit of services can highlight areas of practice ripe for improvement. This was the case for obstetric anal sphincter injury (OASI), when a large-scale review showed an increase in occurrence for primigravid vaginal births (Gurol-Urganci et al, 2013). OASI has long term physical, psychological and social implications for affected women. It is life-changing, and not in a good way.

As a result, the Royal College of Midwives (RCM), Royal College of Obstetricians and Gynaecologists (RCOG), and the London School of Hygiene and Tropical Medicine developed a care bundle, which is a set of evidence-based interventions that, when implemented together, can improve outcomes. The OASI care bundle was piloted in two units to ensure that it was acceptable and feasible for clinicians. Following the pilot, funding was obtained from The Health Foundation to scale up implementation to 16 units (Bidwell et al, 2018).

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