Uptake of a Guideline for the Administration of a Rescue Course of Antenatal Corticosteroids
To evaluate use (both appropriate and inappropriate) of rescue corticosteroids before and after the implementation of a guideline for their use.METHODS:
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.RESULTS:
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.CONCLUSION:
Implementation of an institutional guideline for rescue corticosteroids was associated with a high rate of use among eligible women.