Viva Combs Thorsen, PhD, MPhil Kristine Bonnevies Hus, Auditorium 3
October 7, 2014
Reality Check: Implications of using maternal
death auditing to assess quality of care
Photo taken by Tadej Znidarcic www.tadejznidarcic.com
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Data Collection
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Data analysis 4.
Recommendations 5.
Evaluation
1.
Identification of cases
Surveillance Cycle
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Selected Findings
• Direct cause of death – sepsis & hemorrhage
• Indirect cause of death – anemia
• Within the facility
– inadequate clinical work-ups (history taking and documentation), inadequate monitoring, missed and incorrect diagnoses, delayed or incorrect treatment, lack of blood, lack of drugs, delayed referrals and transfers, patients not being stabilized before referring and severe mismanagement, and outright negligence
• Missing files/information, difficulties identifying appropriate staff and with them speaking candidly about cases; questionable causes of death and clinical diagnoses
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Selected Findings (2)
• Within the community
– Severity of the problem, TBAs and hardships with reaching the facility
• difficulties with locating family and community members and recall biases
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REALITIES
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19 Step in maternal death
surveillance cycle Implications for improving quality of health care
1. Identification of cases
Develop policy (or enforce existing policy) that all maternal cases within the hospital be reported to a designated unit (possibly the clerk’s office of the maternity unit?)
Someone from the maternity unit should be designated to routinely (e.g. weekly or biweekly) visit (or call) all the possible departments where a woman of reproductive age may receive care and inquire about deaths and determine pregnancy status and cross check maternal death case numbers
2. Data collection
Provide refresher courses in conducting and documenting a comprehensive patient assessment Standard case note taking and medical record maintenance/storage should be enforced.
Remedial training and sensitization on the importance of good record keeping practices should be provided.
Systematic case-note audits should be regularly conducted.
Funding from the Ministry of Health and appropriate collaborative partners should be provided to sustain and institutionalize good record keeping practices.
Convey the purpose: to learn from such tragedies to prevent them in the future and not to blame
3. Data analysis
Basic and advanced courses/training in ICD-10 coding, cause of death certification should be provided for appropriate healthcare personnel
Medical doctor or medical officer should facilitate maternal death audits
Feedback loop to all appropriate healthcare staff, especially to those who were involved with caring for the patient in question
4. Recommendations
Healthcare personnel formulate recommendations with senior staff.
Additional funding from the Ministry of Health and appropriate collaborative partners should be provided to implement the recommendations.
Senior staff should take lead and ensure recommendations are implemented.
5. Evaluation Indicators should be formulated and agreed upon by healthcare personnel and senior management. Routine evaluation conducted accordingly
Implications (2)
• Supervision/leadership
• Critical decision making and technical skills
• SOPs for stabilizing patients prior to referral
• SOPs on surveying the inventory of blood and drug supplies
• Health information surveillance system for maternal health
• Assess the wellbeing of staff regularly (e.g. every 6 months)
• Actively monitor caseloads and work patterns
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Researchers against the Machine
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Conclusion
Maternal death audit approach is a cost- effective method for:
•Identifying deficiencies in the health system in general and in the quality of emergency obstetric care specifically
• Identifying/Developing evidence-based solutions
•Improving accountability
• Laying the foundation for investigating others components of the healthcare system
•Taking action!
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