Table 3 Obstacles and facilitators related to guideline and ATLS-based course adherence according to professionals (focus group interview results: qualitative study)
Domain (No barriers found) | Obstacles | Mentioned in No of interviews |
|---|---|---|
Guideline (n = 18) | Items of the PPH-guideline and ATLS-based course instructions are not included in the local hospital protocol | 4 |
The PPH-guideline is difficult to obtain at the delivery ward | 3 | |
Recommendations and definitions in the PPH-guideline are unclear | 3 | |
Professional (n = 28) | Professionals lack awareness regarding the importance of the recommendations of the guideline and ATLS-based course | 4 |
Professionals experience a feeling of time pressure | 4 | |
Professionals overestimate their knowledge regarding identifying the patient-categories at risk for PPH and regarding the treatment of high-risk patients and patients with PPH | 4 | |
Professionals are overconfident regarding their ability to estimate the blood loss without the use of a weighing-scale | 4 | |
Professionals lack to detect high-risk patients at the outpatient clinic | 4 | |
Social setting (n = 7) | Lack of communication in the team responsible for the patient, about the risks, policy, seriousness of the situation or actions that need to be taken | 4 |
Uncertain leadership caused by lack of knowledge about each other’s knowledge and expertise. This is caused by inexperienced professionals and frequent change of team composition | 4 | |
Disagreement between team members and with personnel of other disciplines about the seriousness of the situation (blood-bank personnel and anaesthesiologists) | 3 | |
Lack of team collaboration as orders are not followed and team members prefer following their own instincts in treatments, which leads to inconsequent policy | 3 | |
Presence of hierarchy leads to dread, for team members find it difficult to call in a gynaecologist who is at home and speak freely against the supervisor when there is a disagreement about policy | 3 | |
Organisation (n = 30) | Materials necessary for treatment of patients with PPH are not direct available | 3 |
Shortage of (qualified) staff | 3 | |
Skills/team trainings are not organised or not organised on a regular basis | 3 | |
Lack of practical tools at the delivery rooms, such as checklist/flowchart for easier and practical use of the guideline | 3 | |
Lack of finance | 3 | |
Complication discussions are not organised on a structural basis because it is too time consuming | 3 | |
Facilitators (n = 30) | The availability of a checklist/flowchart about PPH at the delivery rooms would improve care | 4 |
Training on using a checklist/flowchart about PPH would improve care | 4 | |
Skills/team trainings on a regular basis improve care | 3 |