Evaluation of Criteria-Based Clinical Audit in Improving Quality of Obstetric Care in a Developing Country Hospital
), Fawole A.O(2), Sotiloye O.S(3), Otolorin E.O(4),
(1)
(2)
(3)
(4)
Corresponding Author
Abstract
Study evaluated criteria–based clinical audit in measuring and improving quality of obstetric care for five life-threatening obstetric complications: obstetric haemorrhage, eclampsia, genital tract infections, obstructed labor and uterine rupture. Clinical management of 65 patients was audited using a ‘before (Phase I) and after (Phase II)’ audit cycle design using standard criteria. Following Phase I, areas in need of improvement were identified; mechanisms for improving quality of care were identified and implemented. Overall care of the complications improved significantly in obstetric haemorrhage (61 to 81%, p = 0.000), eclampsia (54.3 to 90%, p=0.00), obstructed labour (81.7 to 93.5%, p<0.001) and genital tract sepsis (66 to 85.2%, p < 0.01). Clinical monitoring, drug use, and urgent attention by senior medial staff also improved significantly after intervention. Criteria-based clinical audit is feasible and acceptable for improving management of life-threatening obstetric complications. Its application is recommended in health institutions in developing countries (Afr J Reprod Health 2008; 12[3]:59-70).
RĖSUMĖ
Evaluation à base de critères d’audit clinique dans la qualité d’améliorer le soin obstétrique dans un hôpital du pays en voie de développement L’étude a évalué l’audit clinique basé sur des critères dans les mesures et l’amélioration de la qualité de soin obstétrique pour cinq des complications obstétriques extrêmement graves : hémorragie obstétrique, éclampsie, infections des passages génitaux, accouchement entravé et la rupture utérine. La direction clinique de 65 patients a été vérifiée en se servant du modèle du cycle audit ‘avant (Phase 1) et après (Phase II)’ avec des critères courants. Suivant Phase I, des régions qui ont besoin d’amélioration ont été identifiées ; les mécanismes pour améliorer la qualité de soin ont été identifiées et appliquées. Le soin complet des complications s’est amélioré d’une manière significative dans l’hémorragie obstétrique (61 a 81%, p = 0.000), éclampsie (54,3 a 90%, p = 0.00), accouchement entravé (81,7 a 93,5%, p <0.001) et la septicité du passage génital (66 à 85,2%, p < 0.01). La surveillance clinique, l’usage de drogue et l’attention urgente du personnel médical supérieur ont aussi amélioré significativement après l’intervention. L’audit clinique basé sur des critères est possible et acceptable pour améliorer la direction des complications obstétriques extrêmement graves. Son application est recommandée dans des établissements sanitaires des pays en voie de développement (Afr J Reprod Health 2008; 12[3]:59-70).
Quality of Care, Criteria-based Audit, Obstetric Care, Obstetric Complications
References
World Health Organization. Reduction of maternal mortality; a joint WHO/UNFPA/ UNICEF/World Bank Statement 1999;
World Health Organization, Genera.
Akande EO. Women’s health in Nigeria; past, present and prospects for the next millennium. Afr J Med Sci 2000; 29, 75-82.
World Health Organization. Maternal mortality in 2005. Estimates developed by WHO, UNICEF and UNFPA. Genera:
World Health Organisation, 2007.
Villar J, Carroli G. Gap between evidence and practice. Int J Gynecol Obstet 2001; 75 (Suppl 1): S47 – S54.
Okonofua FE, Abejide A, Makanjuola RA. Maternal mortality in Ile-Ife, Nigeria: A study of risk factors. Stud Fam Plann 1992; 23:319-324.
Roemer MI, Montoya Angular C. Quality assessment and assurance in Primary Health Care, Geneva World Health Organization (WHO Offset Publication No. 105) 1988.
Williams O. What is clinical audit? Ann R Coll Surg Engl. 1996; 78 (5): 406-11
Ahmad MM, Shain RN. The assessment of quality medical care in family planning facilities. Advance in Planned Parenthood 1980; 15 (1): 18-26.
Graham W, Wagaarachchi P, Penny G, MacCaw-Binns A, Yeboah Antwi KI, Hall MH. Criteria for clinical audit of the quality of hospital based obstetric care in developing countries. Bulletin of the WHO 2000; 78 (5): 614-620.
Centre for Disease control (CDC), EPI INFO 6.04b USA. World Health Organization, 1998.
Wagaarachchi PT, Graham WJ, Penney GC, McCaw-Binns A, Yeboah Antwi K, Hall
MH. Holding up a mirror: changing obstetric practice though criterion based clinical audit in developing countries. Gynecol Obstet 2001; 74: 119-130.
Ekwempu CC. Alleviation of maternal mortality and morbidity in the new
Millennium: Time for change? The First John Bateman Lawson Memorial Oration. Trop J Obstet Gynaecol, 2001; 18(1): 43-47.
Wood L. Making audit work. Obstetrician Gynaecologist 2002, 4: 225 – 228.
Weeks A, Ononge S. Audit in maternity Care: A better practice 1. Quality Forum 2001; 2 (2): 1 - 9.
Eclampsia Trial collaborative Group: Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet 1995: 345 – 363.
Schoenboam SC, Gottlieb LK Algorithm based improvement of clinical quality. BMJ 1990; 301: 1374-6
Jamtvedt G, Young JM, Kristffersen DT, O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2006, Issue 2.
African Journal of Reproductive Health Vol 12 No 3 December 2008
Article Metrics
Abstract View
: 499 times
Download : 0 times
Refbacks
- There are currently no refbacks.
