Table 2 Implementation process, intervention components and implementation strategies of the Growth Assessment Protocol, as specified by the intervention provider
Implementation process domains (CICI) | Intervention components | Implementation strategies |
|---|---|---|
Decision to adopt |  | • Recruit sites |
Planning and preparation | • Update the maternity unit’s foetal growth assessment guideline in line with guidance issued by the Perinatal Institute • Audit of baseline rates of detection of the SGA foetus • Trust protocol aligned with GAP | • Identify maternity unit’s GAP team and administration leads (midwife, sonographer, obstetric leads, information technology liaison for hardware and software) • Perinatal Institute convenes monthly meetings between nominated GAP leads from local sites to discuss implementation progress and challenges • Complete baseline audit of rate of SGA, referral for suspected SGA and confirmed SGA detection (3 months’ births) |
Initial implementation | • Annual whole-staff training on the intervention by both face-to-face and e-learning methods | • Selected staff to attend GAP ‘train the trainers’ workshop, led by the Perinatal Institute • Trainers to cascade both face-to-face and e-learning GAP training to 75% of staff from each professional group: midwives, sonographers and obstetricians • Perinatal Institute continues to meet monthly with GAP leads |
Full implementation (‘going live’) | • Risk stratification of pregnant women in early pregnancy into two strata according to whether women are at low or high risk of SGA, using the NHS-England risk-stratification decision tool [15] • Serial fundal height measurements for low-risk women, plotted onto a ‘gestation-related optimal weight’ (GROW) centile chart, which is customised by maternal height, weight, ethnicity and parity [32] • Serial foetal growth ultrasound for high-risk women, with the estimated foetal weight plotted onto the GROW chart • Protocols for the interpretation and onward management of plots on the GROW chart which deviate from the expected growth trajectory | • Use GAP SGA risk assessments and SGA management referrals from ‘go live’ date • Facilitate printing of GROW centile chart and incorporation into individual maternity notes • For low-risk women, begin plotting fundal height measurements onto GROW chart from 26 to 28 weeks every 2–3 weeks • For high-risk women, foetal growth ultrasound every 3 weeks from 26 to 28 weeks until the end of pregnancy • Raise awareness amongst staff of GAP with posters, emails, reminders and in-person visits by GAP leads and trainers to antenatal care settings • Liaise with PI about GAP queries |
Evaluation, reflection and sustainment | • Guidance on the conduct of missed case audit and investigation | • Undertake audit of missed FGR cases (10 cases 6 monthly or 1% of birth rate) |