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Criteria-based audit of quality of care to women with severe pre-eclampsia and eclampsia in a referral hospital in Accra, Ghana.

Browne JL, van Nievelt SW, Srofenyoh EK, Grobbee DE, Klipstein-Grobusch K - PLoS ONE (2015)

Bottom Line: A criteria-based audit is an effective tool to determine quality of care, identify gaps in standard of care, and allow for monitoring and evaluation in a health facility, ultimately resulting in improved quality of care provided and reduced maternal morbidity and mortality.In our audit, good adherence was observed for plan for delivery and treatment with magnesium sulphate.Substandard adherence to a number of protocols was identified, and points towards opportunities for targeted improvement strategies.

View Article: PubMed Central - PubMed

Affiliation: Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.

ABSTRACT

Objectives: Severe pre-eclampsia and eclampsia are one of the major causes of maternal mortality globally. Reducing maternal morbidity and mortality demands optimizing quality of care. Criteria-based audits are a tool to define, assess and improve quality of care. The aim of this study was to determine applicability of a criteria-based audit to assess quality of care delivered to women with severe hypertensive disorders in pregnancy, and to assess adherence to protocols and quality of care provided at a regional hospital in Accra, Ghana.

Methods: Checklists for management of severe preeclampsia, hypertensive emergency and eclampsia were developed in an audit cycle based on nine existing key clinical care protocols. Fifty cases were audited to assess quality of care, defined as adherence to protocols. Analysis was stratified for complicated cases, defined as (imminent) eclampsia, perinatal mortality and/or one or more WHO maternal near miss C-criteria.

Results: Mean adherence to the nine protocols ranged from 15-85%. Protocols for 'plan for delivery' and 'magnesium sulphate administration' were best adhered to (85%), followed by adherence to protocols for 'eclampsia' (64%), 'severe pre-eclampsia at admission' (60%), 'severe pre-eclampsia ward follow-up' (53%) and 'hypertensive emergency' (53%). Protocols for monitoring were least adhered to (15%). No difference was observed for severe disease. Increased awareness, protocol-based training of staff, and clear task assignment were identified as contributors to better adherence.

Conclusion: A criteria-based audit is an effective tool to determine quality of care, identify gaps in standard of care, and allow for monitoring and evaluation in a health facility, ultimately resulting in improved quality of care provided and reduced maternal morbidity and mortality. In our audit, good adherence was observed for plan for delivery and treatment with magnesium sulphate. Substandard adherence to a number of protocols was identified, and points towards opportunities for targeted improvement strategies.

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Related in: MedlinePlus

Mean adherence per protocol for total study sample and stratified by uncomplicated and complicated severe pre-eclampsia (n = 50), Ridge Regional Hospital, Accra, Ghana, 2013.
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pone.0125749.g003: Mean adherence per protocol for total study sample and stratified by uncomplicated and complicated severe pre-eclampsia (n = 50), Ridge Regional Hospital, Accra, Ghana, 2013.

Mentions: Fig 3 shows mean accumulative adherence to the nine protocols for the total study population. Mean adherence to the protocols for severe pre-eclampsia at admission and at follow-up was 60% (range 0–98% and 35–96%, respectively). Protocol for plan of delivery (differentiated by gestational age at admission of 26–31 weeks, 32–34 weeks and >34 weeks) had a mean adherence of 84%, 85% and 94%, respectively. The eclampsia protocol showed a mean adherence of 64% (range 0–100%), with four women eventually experiencing one or more eclamptic convulsion on the ward. For none of these eclamptic convulsions management during the fit(s) was fully described in the patient folders. As a result, a mean adherence to protocol of non-pharmacological treatment during a fit of 26% was seen. For the protocols of non-pharmacological and pharmacological treatment after a fit a mean adherence of 68% and 74% was observed.


Criteria-based audit of quality of care to women with severe pre-eclampsia and eclampsia in a referral hospital in Accra, Ghana.

Browne JL, van Nievelt SW, Srofenyoh EK, Grobbee DE, Klipstein-Grobusch K - PLoS ONE (2015)

Mean adherence per protocol for total study sample and stratified by uncomplicated and complicated severe pre-eclampsia (n = 50), Ridge Regional Hospital, Accra, Ghana, 2013.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4414498&req=5

pone.0125749.g003: Mean adherence per protocol for total study sample and stratified by uncomplicated and complicated severe pre-eclampsia (n = 50), Ridge Regional Hospital, Accra, Ghana, 2013.
Mentions: Fig 3 shows mean accumulative adherence to the nine protocols for the total study population. Mean adherence to the protocols for severe pre-eclampsia at admission and at follow-up was 60% (range 0–98% and 35–96%, respectively). Protocol for plan of delivery (differentiated by gestational age at admission of 26–31 weeks, 32–34 weeks and >34 weeks) had a mean adherence of 84%, 85% and 94%, respectively. The eclampsia protocol showed a mean adherence of 64% (range 0–100%), with four women eventually experiencing one or more eclamptic convulsion on the ward. For none of these eclamptic convulsions management during the fit(s) was fully described in the patient folders. As a result, a mean adherence to protocol of non-pharmacological treatment during a fit of 26% was seen. For the protocols of non-pharmacological and pharmacological treatment after a fit a mean adherence of 68% and 74% was observed.

Bottom Line: A criteria-based audit is an effective tool to determine quality of care, identify gaps in standard of care, and allow for monitoring and evaluation in a health facility, ultimately resulting in improved quality of care provided and reduced maternal morbidity and mortality.In our audit, good adherence was observed for plan for delivery and treatment with magnesium sulphate.Substandard adherence to a number of protocols was identified, and points towards opportunities for targeted improvement strategies.

View Article: PubMed Central - PubMed

Affiliation: Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.

ABSTRACT

Objectives: Severe pre-eclampsia and eclampsia are one of the major causes of maternal mortality globally. Reducing maternal morbidity and mortality demands optimizing quality of care. Criteria-based audits are a tool to define, assess and improve quality of care. The aim of this study was to determine applicability of a criteria-based audit to assess quality of care delivered to women with severe hypertensive disorders in pregnancy, and to assess adherence to protocols and quality of care provided at a regional hospital in Accra, Ghana.

Methods: Checklists for management of severe preeclampsia, hypertensive emergency and eclampsia were developed in an audit cycle based on nine existing key clinical care protocols. Fifty cases were audited to assess quality of care, defined as adherence to protocols. Analysis was stratified for complicated cases, defined as (imminent) eclampsia, perinatal mortality and/or one or more WHO maternal near miss C-criteria.

Results: Mean adherence to the nine protocols ranged from 15-85%. Protocols for 'plan for delivery' and 'magnesium sulphate administration' were best adhered to (85%), followed by adherence to protocols for 'eclampsia' (64%), 'severe pre-eclampsia at admission' (60%), 'severe pre-eclampsia ward follow-up' (53%) and 'hypertensive emergency' (53%). Protocols for monitoring were least adhered to (15%). No difference was observed for severe disease. Increased awareness, protocol-based training of staff, and clear task assignment were identified as contributors to better adherence.

Conclusion: A criteria-based audit is an effective tool to determine quality of care, identify gaps in standard of care, and allow for monitoring and evaluation in a health facility, ultimately resulting in improved quality of care provided and reduced maternal morbidity and mortality. In our audit, good adherence was observed for plan for delivery and treatment with magnesium sulphate. Substandard adherence to a number of protocols was identified, and points towards opportunities for targeted improvement strategies.

Show MeSH
Related in: MedlinePlus