Assessment of quality of care among in-patients with postpartum haemorrhage and severe pre-eclampsia at st. Francis hospital nsambya: a criteria-based audit

BMC Pregnancy and Childbirth, Jan 2017

Background The maternal mortality ratio of Uganda is still high and the leading causes of maternal mortality are postpartum haemorrhage (PPH), severe pre-eclampsia and eclampsia. Criteria-based audit (CBA) is a way of improving quality of care that has not been commonly used in low income countries. This study aimed at finding out the quality of care provided to patients with these conditions and to find out if the implementation of recommendations from the audit cycle resulted in improvement in quality of care. Methods This study was a CBA following a time series study design. It was done in St. Francis Hospital Nsambya and it involved assessment of adherence to standards of care for PPH, severe pre-eclampsia and eclampsia. An initial audit was done for 3 consecutive months, then findings were presented to health workers and recommendations made; we implemented the recommendations in a subsequent month and this comprised three interventions namely continuing medical education (CME), drills and displaying guidelines; a re-audit was done in the proceeding 3 consecutive months and analysis compared adherence rates of the initial audit with those of the re-audit. Results Pearson Chi-Square test revealed that the adherence rates of 7 out of 10 standards of care for severe pre-eclampsia/eclampsia were statistically significantly higher in the re-audit than in the initial audit; also, the adherence rates of 3 out of 4 standards of care for PPH were statistically significantly higher in the re-audit than in the initial audit. Conclusion The giving of feedback on quality of care and the implementation of recommendations made during the CBA including CME, drills and displaying guidelines was associated with improvements in the quality of care for patients with PPH, severe pre-eclampsia and eclampsia.

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Assessment of quality of care among in-patients with postpartum haemorrhage and severe pre-eclampsia at st. Francis hospital nsambya: a criteria-based audit

Lumala et al. BMC Pregnancy and Childbirth Assessment of quality of care among in-patients with postpartum haemorrhage and severe pre-eclampsia at st. Francis hospital nsambya: a criteria-based audit Alfred Lumala 2 Peter Sekweyama 1 Andrew Abaasa 0 Humphrey Lwanga 3 Romano Byaruhanga 1 0 Medical Research Council , Kampala , Uganda 1 Uganda Martyrs University Mother Kevin Postgraduate Medical School , Kampala , Uganda 2 Nkozi Hospital , Kampala , Uganda 3 Mukwaya General Hospital , Kampala , Uganda Background: The maternal mortality ratio of Uganda is still high and the leading causes of maternal mortality are postpartum haemorrhage (PPH), severe pre-eclampsia and eclampsia. Criteria-based audit (CBA) is a way of improving quality of care that has not been commonly used in low income countries. This study aimed at finding out the quality of care provided to patients with these conditions and to find out if the implementation of recommendations from the audit cycle resulted in improvement in quality of care. Methods: This study was a CBA following a time series study design. It was done in St. Francis Hospital Nsambya and it involved assessment of adherence to standards of care for PPH, severe pre-eclampsia and eclampsia. An initial audit was done for 3 consecutive months, then findings were presented to health workers and recommendations made; we implemented the recommendations in a subsequent month and this comprised three interventions namely continuing medical education (CME), drills and displaying guidelines; a re-audit was done in the proceeding 3 consecutive months and analysis compared adherence rates of the initial audit with those of the re-audit. Results: Pearson Chi-Square test revealed that the adherence rates of 7 out of 10 standards of care for severe pre-eclampsia/eclampsia were statistically significantly higher in the re-audit than in the initial audit; also, the adherence rates of 3 out of 4 standards of care for PPH were statistically significantly higher in the re-audit than in the initial audit. Conclusion: The giving of feedback on quality of care and the implementation of recommendations made during the CBA including CME, drills and displaying guidelines was associated with improvements in the quality of care for patients with PPH, severe pre-eclampsia and eclampsia. Criteria-based audit; Postpartum haemorrhage; Pre-eclampsia; Uganda - Background PPH is the leading cause of maternal death contributing 19.7% to maternal mortality globally and it affects approximately 2% of all women who give birth [1, 2]. Hypertensive disorders in pregnancy are the second leading cause of maternal mortality contributing 14% to maternal mortality worldwide; Pre-eclampsia stands out among these disorders as a leading cause of maternal and perinatal morbidity and mortality and it is found in * Correspondence: ; 1Nkozi Hospital, Kampala, Uganda Full list of author information is available at the end of the article 2%–8% of all pregnancies worldwide [3]. Criteria based audit (CBA) is assessing the process component of quality of care provided to patients with a specified condition by comparing the care against explicitly agreed standards [4]. CBA is a method of measuring quality of obstetric care that reliably checks for adherence to guidelines and leads to improvement in quality of care [5]. The CBAs have already been influential in reducing maternal and perinatal mortality in the low income countries, but have not yet been widely used in the low income countries like Uganda [6]. These CBAs have shown positive improvement in the quality of care in © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. some low income counties [7]. This study had an aim of assessing the quality of care given to inpatients with PPH and severe pre-eclampsia in St. Francis Hospital Nsambya as a way of reducing maternal mortality. The specific objective was to determine the improvement in adherence to guidelines during care given to inpatients with PPH and severe pre-eclampsia in St. Francis Hospital Nsambya after implementing recommendations made from an initial audit. Methods St. Francis Hospital Nsambya is a Catholic founded Private-Not-For-Profit tertiary care hospital located in the Southern part of Kampala city, about 3 km from the city centre. It is a tertiary referral hospital with a bed capacity of 361 and an average of 20 deliveries per day. This was a time series (...truncated)


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Alfred Lumala, Peter Sekweyama, Andrew Abaasa, Humphrey Lwanga, Romano Byaruhanga. Assessment of quality of care among in-patients with postpartum haemorrhage and severe pre-eclampsia at st. Francis hospital nsambya: a criteria-based audit, BMC Pregnancy and Childbirth, 2017, pp. 29, 17, DOI: 10.1186/s12884-016-1219-y