Prevention of RhD alloimmunization in Northern British Columbia

Despite best practice guidelines, international evidence suggests that the provision of anti-D prophylaxis to RhD negative pregnant women is suboptimal. Missing from the literature is research exploring the factors that perpetuate suboptimal care and continue to put RhD negative pregnant women at risk for RhD alloimmunization. The purpose of this study was to understand why RhD negative pregnant women continue to be at risk for RhD alloimmunization in northern BC. The specific research questions were: How do healthcare providers make decisions regarding the care of RhD negative pregnancies in northern BC? How do RhD negative women in northern BC experience pregnancy? A qualitative approach utilizing interpretive description was used to address the need for the development of rural centric clinical guidelines. Interviews were conducted with RhD negative women about pregnancy and healthcare providers’ experiences in caring for RhD negative pregnancies in northern BC. A Stakeholder Committee guided the research process and provided insight into data analysis to ensure applicability to practice. A qualitative approach with these two populations has provided a greater understanding into the depth of quality of care for RhD negative pregnancies and the decisions that inform patient safety by revealing nuances of care that lead to potential miscommunication and near misses. Recommendations into guideline adaptation, decision-making and health literacy in rural healthcare settings are presented.