The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands

Abstract

BackgroundPerinatal (mortality) audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in mortality are usually part of the audit group. This makes such an audit a delicate matter.MethodsThe purpose of this study was to implement unit-based perinatal mortality audit in all 15 perinatal cooperation units in the northern region of the Netherlands between September 2007 and March 2010. These units consist of hospital-based and independent community-based perinatal caregivers. The implementation strategy encompassed an information plan, an organization plan, and a training plan. The main outcomes are the number of participating perinatal cooperation units at the end of the project, the identified substandard factors (SSF), the actions to improve care, and the opinions of the participants.ResultsThe perinatal mortality audit was implemented in all 15 perinatal cooperation units. 677 different caregivers analyzed 112 cases of perinatal mortality and identified 163 substandard factors. In 31% of cases the guidelines were not followed and in 23% care was not according to normal practice. In 28% of cases, the documentation was not in order, while in 13% of cases the communication between caregivers was insufficient. 442 actions to improve care were reported for ‘external cooperation’ (15%), ‘internal cooperation’ (17%), ‘practice organization’ (26%), ‘training and education’ (10%), and ‘medical performance’ (27%). Valued aspects of the audit meetings were: the multidisciplinary character (13%), the collective and non-judgmental search for substandard factors (21%), the perception of safety (13%), the motivation to reflect on one’s own professional performance (5%), and the inherent postgraduate education (10%).ConclusionFollowing our implementation strategy, the perinatal mortality audit has been successfully implemented in all 15 perinatal cooperation units. An important feature was our emphasis on the delicate character of the caregivers evaluating the care they provided. However, the actual implementation of the proposed actions for improving care is still a point of concern.

Term perinatal mortality audit in the Netherlands 2010–2012: a population-based cohort study

“…In the chosen approach in the Netherlands an independent chairperson has proven instrumental to optimise audit performance. 18 …”

“…PAN cooperated with the IMPACT project that pioneered the introduction of perinatal audit in the Northern region of the Netherlands. 18 PAN offered regular training sessions in organisation of the audit, in making narratives, in chairing of the audit meeting and in classification of perinatal mortality.…”

Investigating the benefits and challenges of including bereaved women in research: a multifaceted perinatal audit in a socially disadvantaged French district

“…Audits are a key tool for surveillance and evaluation of in utero and infant deaths as shown by those conducted routinely in the UK, 20 Australia and New Zealand 21 and the Netherlands, 22 but bereaved mothers do not participate in providing information for these audit procedures. Audits have not been widely used in France, although there are a few regional examples [23][24][25][26] which have not included bereaved parents.…”

Stillbirth and perinatal care: Are professionals trained to address parents’ needs?

“…When a lower threshold is applied, still only 55% of HCPs were able to recognise at least 80% of recommendations in the Memory section, 50% of them in Aftercare section, and only 4% and 6% in Respect and Birth Options sections, respectively. These inappropriate behaviours may be due to a lack of specific pre-service and inservice for medical staff and midwives, but are probably also maintained by the lack of auditing and undertaking debriefing meetings for perinatal care with regard to perinatal loss support and management ( van Diem et al, 2012 ).…”