Implementing Enhanced Recovery Pathway after Surgery Protocol for Women Undergoing Cesarean Section Delivery

Abstract

Abstract

Background: Women experiencing cesarean section tend to have several problems, so assisting mothers in coping with and solving these problems as well as improving their practices may contribute to decreasing length of stay, reduce post operative complications and achieve early recovery. Aim: to investigate the effect of enhanced recovery pathway after surgery protocol for women undergoing cesarean section delivery. Design: A quasi-experimental design was used. Setting: The study was conducted at Obstetrics and Gynecological department of Benha University Hospital, Benha City, Egypt. Sample: Included two main samples: 1) A convenient sample of all maternity nurses (50) 2) A purposive sample of 200 women undergoing CS divided into two equal groups "100 woman were assigned to the study group who received (ERP) protocol and 100 woman were assigned to the control group who received routine postoperative care. Tools: Five tools were used 1) Self-administered questionnaire for nurses. 2) An observational checklist for nurses. 3) A structured interviewing questionnaire for the women 4) An observational checklist for the women 5) Visual Analogue Scale. Results: There was a highly statistically significant improvement in the total nurses' knowledge and practices after implementation of enhanced recovery passway after surgery (ERP) protocol compared to pre implementation. Also, its application following CS had an effect on improvement of post operative outcome for women as early oral intake, early ambulation, early initiated of breast feeding, less mean pain score, improvement immediately in the practices of mothers as well as decreasing the incidence of health problems in the post-operative period, shorter mean period for length of hospital stay and suture removal. Conclusion: implementation of enhanced recovery passway after surgery (ERP) protocol significantly improved the total knowledge and practices scores of maternity nurses' and significantly improved the postoperative outcome for women, reduce postoperative complications, especially pain, decrease length of stay, improving mother's performance related to breast feeding, early ambulation and post natal exercises. Recommendation: Enhanced recovery passway after surgery protocol should become the standard practices for all women undergoing cesarean section to improve postoperative outcomes and reduce postoperative complications.