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THE CONCEPT OF CLINICAL AUDITS IN OBSTETRIC CARE

THE CONCEPT OF CLINICAL AUDITS IN OBSTETRIC CARE. I. BACKGROUND: Clinical audit. A quality improvement process

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THE CONCEPT OF CLINICAL AUDITS IN OBSTETRIC CARE

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  1. THE CONCEPT OF CLINICAL AUDITS IN OBSTETRIC CARE

  2. I. BACKGROUND: Clinical audit • A quality improvement process • 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.

  3. I. BACKGROUND: Clinical audit in obstetric care It also implies the retrospective critical review of clinically undesirable pregnancy related events

  4. 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.

  5. III. WHY CONDUCT AN AUDIT? • Improve clinical care and outcome • Enhance rational use of limited resources • Thro rejection of less useful and implement useful interventions. E.g. episiotomies, CS vs vacuum • Improve staff morale and motivation • Criterion based audit provides significant educational value • Involves provision of feedback on the quality of performance → improves performance, motivation

  6. IV. MATERNAL/PERINATAL MORTALITY AUDITS - OBJECTIVES • To determine the primary and final causes of death, • To identify mismanagement (preventable factors and missed opportunities). • To ascertain how to improve future management.

  7. 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

  8. V. PREVENTABLE FACTORScont 3. Patient related: • Where a woman by not doing something contributed to her death. e.g. delay to come to the HF

  9. 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

  10. 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.

  11. Proposed Members of the Perinatal Mortality Audit Team: Tanzanian Guideline • Health facility in-charge • Matron • Doctors in Obstetric department • Nurse incharge - labour ward, neonatal unit • Representatives from the pharmacy, theatre • Head - laboratory • DMO • District RCH coordinator • DNO

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