7/28/2019 Sengendo: Perinatal Audits for Improved Care

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PERINATALAUD

ITSFORIMPROVE

D

CARE

DrNaamalaHanifahSen

gendo

SavetheChildren

GlobalN

ewbornConfere

nce

JohannesburgApril201

3

MinistryofHealth

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PresentationOu

tline

Keydefinitio

ns

Auditcycle

Ugan

dacountryexperience

Lessonslearnt

Challenges

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KEYDE

FINITION

S

Auditis

awell-descr

ibedmethodofsystem

atic,

criticalanalysisofqualityofm

edicalcare

Perinatal

periodsurroundingbirt

h,andinclu

des

thetimefromfetalviabilityofpregnancyupto7

daysoflife.

Perinatal

deathsincludestillbirth

sandearly

neonatal

deaths.

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Wha

tisPerinatalmortalityaudit?

Theprocesso

fmulti-d

isciplinary,

no-fa

ultrevie

wofcaregivento

pregnantwom

en,theirunborn

babiesandth

eirneonatesafte

ra

deathoccurs

withanaimto

improvecare.

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PerinatalMortality

Audit

Mortalityauditcanreducedeathsb

yupto30%b

ut

onlyifda

taareusedeffectivelyand

clearlylinked

to

action.

In2008,maternalauditwasapresid

entialdirective

Multifactorialetiology

dependingonSES,accessto

healthca

reandqualityofthathealt

hCare.

Sub-optimalobstetriccareisrespon

siblefor75%

of

perinataldeathsinlow

IncomeCountries

Avoidab

lecausesofdeatharedue

simpleerrorsor

omission

sinbasichealthcare

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THEAUDITCY

CLE

P

roblemor

objective

identified

Criteriaagreeda

nd

standardsset

Audit(Data

collected)

Identifyareasfor

im

provement

Make

necess

ary

chang

es

Re-a

udit

Game

changer

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Effectiveaudit

Confidential,no-fault

Aned

ucationalactivity

Prom

otesunderst

anding

Resourceeffective

Raise

sstandards

Prom

oteschange

Sourc

eofinforma

tion

Peerledandmulti-disciplinary

?????

Involvespatientsandcommunity

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How

does

mortalityaudit

impr

ovecare

?

Caregiversareinfo

rmedofth

eirdeficiencies

orimpro

vementso

nPrincip

lesof:

Focus

singonthe

data-base

dproblem

sand

burden

Focus

singonsys

temsandprocesses

Using

localdata

Multi-disciplinaryteamwo

rk/collaboration

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Ugandaperinatalauditexperience

OnePNFPhospitalleadintrodu

ctionofaud

itbut

nowide

-scalerollou

t

MoHan

dSCintroducedmatern

alandperin

atal

auditinaUgandandistricthospitalin201

1with

anaimtoscaleup

Trained

30frontline

HWsands

upportstaff

Formed

afacility-ba

sedMPDRc

ommitteew

itha

Chairman,Secretaryandhospit

aladministr

ator

Formula

tedadatef

ortheregularmortality

reviewmeetinsw

eekl

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A

uditexperience(

contd)

Pilotph

ase:20out

of30perinataldeathswere

thoroughlyaudited

within3months

Created

afileforcasesummar

iesandaudit

notes

Recording,tracking

andimplem

entationof

workab

lesolutions

Supportsupervisionandmento

rshipdone

includin

gpartnerin

gwithPNFP

hospital

Paper-b

asedsystem

converted

toelectronic

datacannowbeen

teredonce

llphonesan

d

compiledcentrally

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Perinatalreportingdashboardexam

ple

Case

summary

Cau

sesof

dea

th

Avoidable

factors

Action

planned

Byw

hom

ByWhen

Comments

onpending

actions

Case1

Case2

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Majorg

apsidentifiedth

rougha

udit

lea

dingtoavoidabl

edeaths

Patientfactors

Delayindecidingtoseekcare/reachingthehealthfacility

Healthw

orkerfactors

Poorhistorytakingand

examination

Poorre

suscitationskills

Lackof

knowledgeonpartographuse

Noearlypostnatalreviewofbabiesbe

foredischarge

Administrativefactors

Antena

talrecordsnotlinkingtodelivery

Irregularrequisitionan

dsupplyofdrugsandequipment

Station

erynotavailable

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A

CTIONS

IMPLEM

ENTED

Patientfactors

LinkwithVHT,createdemandandkn

owledgeofwhento

seekcare

Healthw

orkerfactors

ContinuousMedicalEducation,e.g.intrapartumcare

training,partographrefresher

Improv

etargetedsupervision

Administrativefactors

Internalorganizationchangese.gDutyRotaforDrscoverag

eof

maternitywards

In-chargewasdesigna

tedtofacilitate

stockingofdrugs

Audite

ndorsedasaroutineactivityo

fthehospitala

nd

supportedbythedistrict

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Preliminarycha

nges

Increaseintimelyc

aesareanse

ction

Improveddocumen

tationinclu

dinghistory

taking,

notingtime

andactions

taken

Partogr

aphuseimp

roved

Improvedknowledgeandskills

Administrationmoreresponsiv

e

Innovativeprocess

estomakemeetings

shorter

fewerdea

thsaudited

withmore

concret

eactions

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Challenges

FatigueofHWs

Staffattritionand

lossofau

ditchampions

Victimizationke

ytomaintainno-blame

environment

Inadeq

uateutilizationofau

ditdata

Lackofaudittools

Lackofactionsforadministrativefactors

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Less

onslear

nt

Problem

mustbea

ddressed,

notthepe

rson

Adminis

tratorparticipationiskey

Toolsmustbeuserfriendly

short,electronic

Integrat

ewithmaternalnear

-missaudit

Harmon

izationofICDcauses

toidentify

true

causesofdeath

Avoidab

lefactorsshouldbemodifiable

Successesshouldalsobediscussed

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Conclusion

Audit

isagoods

tartingpointforimproved

qualit

yofcarebutneedstolinktoaction

Morta

lityauditr

equiresge

neralhealth

system

sstrength

ening(includingHMIS)

Outstandingresearchques

tions:

Sustainableappro

achestocontinuousmortality

audit;

Effec

tiveuseofda

ta;

Com

munityinvolvement