Safety and quality in maternal and neonatal care: the introduction of the modified WHO Safe Childbirth Checklist

Abstract

Maternal and neonatal mortality and morbidity associated with childbirth is a problem of the highest priority. This research has been aimed at testing a modified version of the WHO Safe Childbirth Checklist in one Italian hospital and to evaluate the tool in terms of its impact on clinical practice and safety. Results show that the presence of correctly compiled partogram tool is strongly and significantly associated with the checklist implementation (OR = 14.9, 95% confidence interval [CI] = 3.5, 63.9). Compliance to the checklist was high for mid-wives (96%) and very low for obstetricians (3%). The discrepancy is the result of a misinterpretation by obstetricians: they signed only in case they prescribed therapy or when they identified risk factors, but not to underline that they checked for those factors independently by their existence. While the checklist promotes the interdisciplinary work, field studies generally show strong hierarchical rather than partnership interaction. Practitioner Summary: The study is aimed at evaluating: the checklist impact on clinical practice through a prospective pre- and post-intervention study based on clinical records review, the usability of the tool and the user's compliance. The research gives evidences on the importance of the tool for reducing risks related to delivery.

Effectiveness of utilizing the WHO safe childbirth checklist on improving essential childbirth practices and maternal and perinatal outcome: A systematic review and meta-analysis

“…Three studies were cluster-randomized (Varghese et al [14], Semrau et al [21], and Kumar et al [7]). Six studies were-random pre-and-post intervention study (Albolino et al [22], Kabongo et al [9], Nababan et al [11], Spector et al [3], Varaganti et al [12] and Tuyishime et al [10]). Only the study by Kumar et al (2016) was concealed by central allocation (Fig 3).…”

“…Also, another two pre-and-post intervention studies were conducted in India (Spector et al [3], and Varaganti et al [12]). The other four pre-and-post intervention studies were conducted in Italy (Albolino et al [22]), Namibia (Kabongo et al [9]), Bangladesh (Nababan et al [11]), and Rwanda (Tuyishim et al [10]) respectively. Two studies were conducted at a tertiary health facility (Albolino et al [22] and Varaganti et al [12]) whereas four (Kabongo et al [9], Nababan et al [11], Tuyishim et al [10], and Varghese et al [14]) at the district health facility, two (Semrau et al [21] and Spector et al [3]) at the subdistrict health facility and one (Kumara et al [7]) at both district and subdistrict health facility (Table 1).…”

“…Blinding of health professionals is not possible in all studies as it involves training and introduction of the checklist. Still, three of the studies are cluster randomized with similar data collection for both control and intervention facilities (Varghese et al [14], Semrau et al [21] and Kumar et al [7]) and one study collected retrospectively from documents (Albolino et al [22]). Five studies collected data by observation of health workers practice which might have introduced hawthorn effect (Albolino et al [22], Kabongo et al [9], Nababan et al [11], Spector et al [3], Varaganti et al [12] and Tuyishime et al [10]) (Fig 3).…”

“…Data collectors didn't know intervention and control facilities in three studies (Varghese et al [14], Semrua et al [21], and Kumar et al [7]). Four studies were not blinded but used a pre-defined checklist and unlikely to affect the outcome of the study (Albolino et al [22], Kabongo et al [9], Nababan et al [11], Spector et al [3], and Tuyishime et al [10]). In one study, investigators were involved in data collection (Kabongo et al [9]), and one study didn't report data collection methods (Varaganti et al [12]) (Fig 3).…”

Health and social care ergonomics: patient safety in practice

“…The SEIPS model is also used by Heiden and Caldwell (2017) to discuss and propose a new systems model for service provision of Traumatic Brain Injury management as a chronic disease. A systemic and multimodal approach was also used by Albolino et al (2017) with clinicians to co-create and evaluate an adaptation of the WHO Safe Childbirth Checklist (WHO 2015) aiming to reduce risks related to maternal and neonatal care.…”