Uptake of a Guideline for the Administration of a Rescue Course of Antenatal Corticosteroids.

Published

Journal Article

To evaluate use (both appropriate and inappropriate) of rescue corticosteroids before and after the implementation of a guideline for their use.We conducted a retrospective cohort study using a pharmacy log to identify women who received an initial course of antenatal corticosteroids in the year before (2008) and in the 4 years (2009-2012) after implementation of the guideline. The charts were then reviewed to determine eligibility and assess receipt of rescue corticosteroids according to the guideline. Our primary study outcome was a temporal change in the percentage of appropriate rescue corticosteroid administration.Of 2,528 women who received a first course of corticosteroids, 142 (5.6%) were eligible for a rescue course, of whom 103 (73%) received it. The rate of appropriate administration increased from 18.2% (95% confidence interval [CI] 5-40%) in 2008 to 65.4% (95% CI 44-83%) in 2009, 93.5% (95% CI 79-99%) in 2010, 96.1% (95% CI 80-99%) in 2011, and 75.7% (95% CI 59-88%) in 2012 (P for test of trend <.001). Only 25 of these 103 eligible women (24.3%) delivered within 2-7 days of receipt of the rescue course. The rate of inappropriate administration among women who were not eligible for a rescue course (n=2,381) also rose from 0.4% (95% CI 0.04-1.4%) in 2008 to 1.9% (95% CI 0.9-3.5%) in 2009, 1.8% (95% CI 0.8-3.6%) in 2010, 2.4% (95% CI 1.2-4.3%) in 2011, and 2.2% (95% CI 1.1-4.0%) in 2012 (P for test of trend=.03). Among all recipients of rescue corticosteroids, 28% (41/144) were ineligible according to the guideline.Implementation of an institutional guideline for rescue corticosteroids was associated with a high rate of use among eligible women.

Full Text

Duke Authors

Cited Authors

  • Datkhaeva, I; Dray, D; Has, P; Stifani, B; Hughes, BL; Rouse, DJ

Published Date

  • April 2017

Published In

Volume / Issue

  • 129 / 4

Start / End Page

  • 720 - 726

PubMed ID

  • 28277360

Pubmed Central ID

  • 28277360

Electronic International Standard Serial Number (EISSN)

  • 1873-233X

International Standard Serial Number (ISSN)

  • 0029-7844

Digital Object Identifier (DOI)

  • 10.1097/aog.0000000000001934

Language

  • eng