THE CONCEPT OF CLINICAL AUDITS IN

OBSTETRIC CARE

I. BACKGROUND: Clinical audit

1. A quality improvement process

2. Goal: To improve patient care and

outcomes through systematic assessment

of practice against a defined standard, with

a view to recommending and

implementing measures to address specific

deficiencies in care.

I. BACKGROUND: Clinical audit in obstetric

care

It also implies the retrospective

critical review of clinically

undesirable pregnancy related

events

II. AREAS FOR CLINICAL AUDIT

Maternal and perinatal deaths - common The near misses - maternal survivors of

fatal morbidity. Routine clinical practices against evidence

based standards Partogram use in labur, Referral norms.

III. WHY CONDUCT AN AUDIT?

1. Improve clinical care and outcome

2. Enhance rational use of limited resources Thro rejection of less useful and implement useful

interventions. E.g. episiotomies, CS vs vacuum

3. Improve staff morale and motivation Criterion based audit provides significant

educational value Involves provision of feedback on the quality of

performance → improves performance, motivation

IV. MATERNAL/PERINATAL MORTALITY AUDITS - OBJECTIVES

1. To determine the primary and final causes of death,

2. To identify mismanagement (preventable factors and missed opportunities).

3. To ascertain how to improve future management.

V. PREVENTABLE FACTORS

1. Health worker related:

Where a health provider did not do something which had a direct influence on the maternal/perinatal death.

e.g. failure to institute appropriate and timely treatment

2. Administrative related: Where something that is the responsibility of the

health authority was not available. e.g. equips, drugs & supplies

V. PREVENTABLE FACTORS cont

3. Patient related:

Where a woman by not doing

something contributed to her death.

e.g. delay to come to the HF

VI. EFFECTIVE MATERNAL/ PERINATAL

MORTALITY AUDIT

A cycle that consists of: Identifying cases, Collecting information, Analysing the results, Formulating recommendations, Implementing change and Re-evaluating practice, and this cycle must be

repeated regularly

PRACTICE IN THE ABSENCE OF AUDIT

Denies health staff information about

their strength and weaknesses in their patient care activities and therefore;

Failure to improve care.

Proposed Members of the Perinatal Mortality Audit Team: Tanzanian Guideline

1. Health facility in-charge

2. Matron

3. Doctors in Obstetric department

4. Nurse incharge - labour ward, neonatal unit

5. Representatives from the pharmacy, theatre

6. Head - laboratory

7. DMO

8. District RCH coordinator

9. DNO