Improving Quality of Care for Maternal and Newborn Health: Prospective Pilot Study of the WHO Safe Childbirth Checklist Program

Abstract

BackgroundMost maternal deaths, intrapartum-related stillbirths, and newborn deaths in low income countries are preventable but simple, effective methods for improving safety in institutional births have not been devised. Checklist-based interventions aid management of complex or neglected tasks and have been shown to reduce harm in healthcare. We hypothesized that implementation of the WHO Safe Childbirth Checklist program, a novel childbirth safety program for institutional births incorporating a 29-item checklist, would increase delivery of essential childbirth practices linked with improved maternal and perinatal health outcomes.Methods and FindingsA pilot, pre-post-intervention study was conducted in a sub-district level birth center in Karnataka, India between July and December 2010. We prospectively observed health workers that attended to women and newborns during 499 consecutively enrolled birth events and compared these with observed practices during 795 consecutively enrolled birth events after the introduction of the WHO Safe Childbirth Checklist program. Twenty-nine essential practices that target the major causes of childbirth-related mortality, such as hand hygiene and uterotonic administration, were evaluated. The primary end point was the average rate of successful delivery of essential childbirth practices by health workers. Delivery of essential childbirth-related care practices at each birth event increased from an average of 10 of 29 practices at baseline (95%CI 9.4, 10.1) to an average of 25 of 29 practices afterwards (95%CI 24.6, 25.3; p<0.001). There was significant improvement in the delivery of 28 out of 29 individual practices. No adverse outcomes relating to the intervention occurred. Study limitations are the pre-post design, potential Hawthorne effect, and focus on processes of care versus health outcomes.ConclusionsIntroduction of the WHO Safe Childbirth Checklist program markedly improved delivery of essential safety practices by health workers. Future study will determine if this program can be implemented at scale and improve health outcomes.

Avaliação da adesão à Lista de Verificação de Segurança no Parto em uma maternidade pública no Nordeste do Brasil

“…Tal relação pode ser confirmada em estudo futuro desenhado para tal fim. Os dados corroboram com achados de outros estudos, que indicam elevada frequência de realização de práticas não recomendadas em detrimento de medidas benéficas e baseadas em evidências 10,20 . Deve-se, com isso, adotar práticas pautadas em um modelo humanizado de atendimento como a aplicação da Lista de Verificação de Segurança no Parto, desestimulando, por outro lado, uma assistência excessivamente intervencionista promotora de desfechos negativos 25 .…”

“…Países como o Chile apresentaram redução acentuada desses indicadores por readequação dos serviços de saúde voltados para a sua prevenção 9 . A Lista de Verificação de Segurança no Parto foi testada em dez países da África e da Ásia, e contém 29 itens 10,11 , que estão relacionados às principais causas de mortes maternas (hemorragia, infecção, trabalho de parto obstruído e distúrbios hipertensivos) 10 , natimortos relacionados ao intraparto (cuidados intraparto inadequados) e mortes neonatais (asfixia perinatal, infecção e complicações da prematuridade) em países de baixa renda 10,12 .…”

“…Apesar de poucos estudos já publicados em relação à implantação da Lista de Verificação de Segurança no Parto, um grande estudo randomizado na Índia evidenciou que o uso desse instrumento é capaz de, quando implementado de forma eficaz, contribuir para a melhora da qualidade da assistência à saúde materna e neonatal uma vez que determina um aumento na realização de práticas obstétricas essenciais 4,10 . A baixa qualidade do cuidado em partos institucionais é reconhecida como o maior fator de risco para desfechos negativos relacionados ao parto 13 .…”

Review article: Perioperative checklist methodologies

“…14 Another recent WHO initiative aimed at improving maternal and neonatal outcomes and reducing complications and deaths evaluated the effect of a checklist on 29 essential peripartum practices. 19 Results of the initiative showed an increase in the delivery of essential care practices during childbirth from an average of 10 at baseline to 25 following implementation.…”

Influence of hospital policy on partograph use in tertiary care facilities in India: a cross sectional survey

“…2 Despite this, the use of partogram is very low among healthcare providers in developing countries, including in India. [3][4][5][6] Poor knowledge and skills in plotting partograph, shortage of staff, and non-availability of printed partograph sheets are commonly cited reasons for under-utilization of partograph. 3,4,7 To the best of our knowledge, the influence of hospital policy on the knowledge, attitude and practice of doctors towards partograph plotting in tertiary care settings has not been reported.…”