EVALUATION OF THE QUALITY AND MANAGEMENT OF MATERNITY SERVICES IN THE NATIONAL DISTRICT HOSPITAL IN

THE FREE STATE PROVINCE

5 DECEMBER 2012PRESENTER: AS SESING

MCWH MANAGER(FSDOH)

Maternity services are essential components of the health system at all levels of care.

Services are managed according to specific policies, protocols and guidelines.

Despite having systems in place, South Africa is facing challenges with maternity services in terms of poor management of the services and systems not functioning well.

In the National District Hospital (NDH) the bed occupancy is very low but nurses complain that there is high number of day patients that are captured in the information system.

Also anecdotal evidence that unit had poor performanceThe aim of this study was to evaluate the performance of the

maternity unit at the National District Hospital.

INTRODUCTION

FREE STATE PROVINCE MAP

NDH is one of the four district hospitals in Motheo District in the Free State province

The hospital renders a package of services to 500 000 population in the catchment area which is constantly growing

The hospital is located in Bloemfontein which is the most urban area of Motheo district

The city is the trade and administrative hub of the province and has a university, technicon and tertiary colleges

NDH renders 24hours Maternity, Emergency and Radiographic services and 8hours Theatre services

NATIONAL DISTRICT HOSPITAL BACKGROUND INFORMATION

The study was conducted in the maternity unit at NDH Period 2006 – 2008 A cross sectional study design was used comprising

retrospective review of various records Data was collected on various variables that are relevant to the

performance of maternity services Ethical approval and permission from authorities to do study

was obtained Confidentiality was strictly maintained Data was entered onto Excel spreadsheets, cleaned and

imported into EpiInfo for analysis Descriptive statistics were first done

◦ To test for difference across the years, ◦ tests for association were used.◦ A p – value of 0.05 was considered to be significant

METHODOLOGY

Calculated caseload as data from various sources

Patient profile There is a slight change in the profile recently

with significant more White and married patients being admitted in 2008

Length of stay Length of stay was very short with 50% of

patients being discharged in a day

RESULTS

HIV Investigation

2006 (n=30) 2007 (n=30) 2008 (n=30)

Pre counselingYesNoNot recordedCard missing

14916

11694

170103

TestingYesNoNot recordedCard missing

16341

105114

92163

Result statusYesNoNot recordedCard missing

41541

110154

45183

Post counselingYesNoNot recordedCard missing

14361

10794

130143

Recording not done in relation to HIV counseling, testing, results and treatment (Figure 3).

Percentage of section on the patient records fully completed on admission (Figure 4).

Percentage of sections on Partogram fully completed during the labour process.(Figure 5).

indicators 2006 2007 2008

Bed occupancy rate 60% 56.6% 62.9%

Caesarean section rate 6.88% 8.9% 6.86%

Monthly PNR meetings 9 months 11 months 9 months

Adverse events/Complaints

4 3 3

UNIT SUPERVISION

Gaps in the management of the patients care rendered in the maternity unit which indicated substandard quality of care

Support system not considered Non adherence to guidelines and protocols Poor record keeping Data collection mismanagement Unit supervision not up to the required

standard

DISCUSSION AND CONCLUSION

Study based on record review only No interviews were done Information on patients records and

registers were a problem Records of referred patients were excluded The study did not investigate resource

allocation and its utilization

LIMITATIONS OF THE STUDY

Need to benchmark good and best practices Have a family oriented care – support

system Train and retrain service providers Need to improve the patients’ registry Improve supervision of the unit Improve information management system –

Perinatal review meetings

RECOMMENDATIONS

Continuity of care use of H10 Importance of initial assessment on

admission Involvement of support system Use of partogram for patients in labour Improving Perinatal review meetings for

compliance

IMPROVING QUALITY OF INPATIENT SERVICES

World Health Organization.2005.Reducing Maternal Death: The Challenge of the New Millennium in the African Region.Geneva.WHO.

National Department of Health. 2007. Guidelines for Maternity Care and District Hospitals. Pretoria. Department of Health.

REFERENCES

My supervisor Dr. R Jina Wits Medical School The National District Hospital Free State Department of Health

ACKNOWLEDGEMENTS