Phase 1: Stakeholder mapping and patient journey mapping - Antimicrobial Prophylaxis in pregnancy

Project Partners

Choosing Wisely Canada

Maternal Newborn Child and Youth Strategic Clinical Network (MNCY SCN)

Obstetrical networks within hospitals and cities

Primary care providers

Tertiary care and birthing centers (urban and rural)

Members of obstetrical care teams (nurses, midwives, general practitioners)

Background

Antimicrobial optimization in pregnancy is essential for protecting maternal and neonatal health. Despite this, many pregnant patients are prescribed alternative antibiotics due to inaccurate penicillin allergy labels. Choosing Wisely Canada notes that up to 98% of those labeled allergic can safely receive beta-lactam antibiotics like penicillin or cefazolin. Inappropriate antibiotic use increases the risk of surgical site infections, C. difficile, extended hospital stays, and antibiotic resistance in newborns.

Aims/Objectives

Optimize antimicrobial prophylaxis in perinatal care

Identify barriers to appropriate antibiotic use in pregnancy

Map current perinatal care processes to understand the problem space

Engage with networks and care providers to guide dissemination strategies

Support development of an intervention based on identified gaps and practices

Findings/Summary

In Alberta, 10,000–15,000 pregnant individuals receive antibiotics during labor and delivery annually to prevent infections like surgical site infections and early-onset GBS disease. Phase 1 of the project focused on stakeholder engagement and comprehensive process mapping. Engagement efforts grouped key stakeholders—healthcare providers, networks, and organizations—by care setting and role. A detailed patient process map was created to trace the perinatal pathway for individuals needing antibiotic prophylaxis. This involved reviewing documentation, protocols, and communication strategies related to prenatal allergy identification and antibiotic risk assessment. This foundational work provides insight into existing care gaps and systemic barriers to optimal antibiotic use.

Conclusions/Outcomes/Impact/Implications

This foundational phase supports the development of targeted interventions to improve antibiotic use in pregnancy. By identifying inconsistencies in allergy labeling and perinatal care practices, the project enables more effective, guideline-concordant antimicrobial prophylaxis. The outcomes will inform future quality improvement efforts and enhance maternal and neonatal health through better clinical decision-making and care standardization.