Fidelity of an Implementation Strategy for a Maternal Early Warning System Protocol at a Tertiary Care Center

INTRODUCTION: Maternal Early Warning System (MEWS) protocols are promising clinical tools to enhance maternal care for acute conditions. Effective implementation of new evidence-based practices relies on implementation fidelity (i.e., the degree to which the implementation strategy is delivered as intended). Thus, we evaluated the fidelity of the implementation strategy for the MEWS protocol, with a focus on educational activities. METHODS: This cross-sectional evaluation was part of a Quality Improvement initiative. We used a fidelity framework assessing adherence (alignment with design), dose (amount/intensity), and participant responsiveness (engagement and adoption) to the implementation strategy. Results were summarized with descriptive statistics and content analysis. RESULTS: The implementation comprised 20 out of 21 planned training and orientation activities, including multidisciplinary simulations, skills drills, and departmental Grand Rounds. These activities were attended by 246 participants (137 nurses, 40 residents, 36 physicians, and allied-health professionals), of whom 77 (31.3%) completed the post-session survey. In a post-session survey, 52.6% (n = 40/76) and 43.4% (n = 33/76) of participants reported feeling "extremely comfortable" escalating care and activating a code blue, respectively. Qualitative feedback from 23 respondents identified benefits in autonomy/confidence (n = 9), safety (n = 6), communication (n = 3), and teamwork (n = 3), while emphasizing bias reduction in patient assessments (n = 5) and patient-centered care (n = 6) in emergency situations. CONCLUSION: Most sessions were completed as intended and led to high participant engagement. Responsiveness results suggest that the implementation strategy prepared healthcare providers for uptake of the MEWS protocol and supported them in carrying out patient-centered assessments, while maximizing professional autonomy/collaboration, and optimizing equitable care delivery.