TY - JOUR
T1 - Adapting the FAST-M maternal sepsis intervention for implementation in Pakistan
T2 - a qualitative exploratory study
AU - Ahmed, Sheikh Irfan
AU - Khowaja, Bakhtawar M.Hanif
AU - Barolia, Rubina
AU - Sikandar, Raheel
AU - Rind, Ghulam Kubra
AU - Khan, Sehrish
AU - Rani, Raheela
AU - Cheshire, James
AU - Dunlop, Catherine Louise
AU - Coomarasamy, Arri
AU - Sheikh, Lumaan
AU - Lissauer, David
N1 - Funding Information:
This research study is funded by the National Institute for Health Research (NIHR). Award Ref: NIHR300808 Host: University of Liverpool. The views expressed in this paper are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/9/9
Y1 - 2022/9/9
N2 - Objective A maternal sepsis management bundle for resource-limited settings was developed through a synthesis of evidence and international consensus. This bundle, called FAST-M' consists of: Fluids, Antibiotics, Source control, assessment of the need to Transport/Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). The study aimed to adapt the FAST-M intervention including the bundle care tools for early identification and management of maternal sepsis in a low-resource setting of Pakistan and identify potential facilitators and barriers to its implementation. Setting The study was conducted at the Liaquat University of Medical and Health Sciences, which is a tertiary referral public sector hospital in Hyderabad. Design and participants A qualitative exploratory study comprising key informant interviews and a focus group discussion was conducted with healthcare providers (HCPs) working in the study setting between November 2020 and January 2021, to ascertain the potential facilitators and barriers to the implementation of the FAST-M intervention. Interview guides were developed using the five domains of the Consolidated Framework for Implementation Research: intervention characteristics, outer setting, inner setting, characteristics of the individuals and process of implementation. Results Four overarching themes were identified, the hindering factors for implementation of the FAST-M intervention were: (1) Challenges in existing system such as a shortage of resources and lack of quality assurance; and (2) Clinical practice variation that includes lack of sepsis guidelines and documentation; the facilitating factors identified were: (3) HCPs' perceptions about the FAST-M intervention and their positive views about its execution and (4) Development of HCPs readiness for FAST-M implementation that aided in identifying solutions to potential hindering factors at their clinical setting. Conclusion The study has identified potential gaps and probable solutions to the implementation of the FAST-M intervention, with modifications for adaptation in the local context Trial registration number ISRCTN17105658.
AB - Objective A maternal sepsis management bundle for resource-limited settings was developed through a synthesis of evidence and international consensus. This bundle, called FAST-M' consists of: Fluids, Antibiotics, Source control, assessment of the need to Transport/Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). The study aimed to adapt the FAST-M intervention including the bundle care tools for early identification and management of maternal sepsis in a low-resource setting of Pakistan and identify potential facilitators and barriers to its implementation. Setting The study was conducted at the Liaquat University of Medical and Health Sciences, which is a tertiary referral public sector hospital in Hyderabad. Design and participants A qualitative exploratory study comprising key informant interviews and a focus group discussion was conducted with healthcare providers (HCPs) working in the study setting between November 2020 and January 2021, to ascertain the potential facilitators and barriers to the implementation of the FAST-M intervention. Interview guides were developed using the five domains of the Consolidated Framework for Implementation Research: intervention characteristics, outer setting, inner setting, characteristics of the individuals and process of implementation. Results Four overarching themes were identified, the hindering factors for implementation of the FAST-M intervention were: (1) Challenges in existing system such as a shortage of resources and lack of quality assurance; and (2) Clinical practice variation that includes lack of sepsis guidelines and documentation; the facilitating factors identified were: (3) HCPs' perceptions about the FAST-M intervention and their positive views about its execution and (4) Development of HCPs readiness for FAST-M implementation that aided in identifying solutions to potential hindering factors at their clinical setting. Conclusion The study has identified potential gaps and probable solutions to the implementation of the FAST-M intervention, with modifications for adaptation in the local context Trial registration number ISRCTN17105658.
KW - health & safety
KW - infectious diseases
KW - obstetrics
KW - public health
KW - reproductive medicine
UR - http://www.scopus.com/inward/record.url?scp=85138214875&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2021-059273
DO - 10.1136/bmjopen-2021-059273
M3 - Article
AN - SCOPUS:85138214875
SN - 2044-6055
VL - 12
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - e059273
ER -
