Decreased rates of shoulder dystocia and brachial plexus injury via an evidence-based practice bundle

Objective: To evaluate whether a standardized approach to identify pregnant women at risk for shoulder dystocia ( SD) is associated with reduced incidence of SD and brachial plexus injury ( BPI). Methods: Between 2011 and 2015, prospective data were collected from 29 community-based hospitals in the USA during implementation of an evidence-based practice bundle, including an admission risk assessment, required "timeout" before operative vaginal delivery (OVD), and low-fidelity SD drills. All women with singleton vertex pregnancies admitted for vaginal delivery were included. Rates of SD, BPI, OVD, and cesarean delivery were compared between a baseline period (January 2011-September 2013) and an intervention period (October 2013-June 2015), during which there was a system-wide average bundle compliance of 90%. Results: There was a significant reduction in the incidence of SD (17.6%; P= 0.028), BPI (28.6%; P= 0.018), and OVD (18.0%; P< 0.001) after implementation of the evidence-based practice bundle. There was a nonsignificant reduction in primary (P= 0.823) and total (P= 0.396) cesarean rates, but no association between SD drills and incidence of BPI. Conclusion: Implementation of a standard evidence-based practice bundle was found to be associated with a significant reduction in the incidence of SD and BPI. Utilization of low-fidelity drills was not associated with a reduction in BPI.