Improving Maternity Care through Evidence

1
Improving Maternity Care through Evidence

• References
• ALSO Course Syllabus (2000)
• WHO Regional Credentialing Program

2
Quality in Maternity Care

• Doing the right thing
• the first time
• in the right way
• and at the right time

3
Essential elements of quality improvement

• Leadership

Measurement
Improvement
4
Why bother .?

• Most health care is provided safely and
  appropriately
• but .
• sometimes things go wrong or put technically an
  adverse event occurs!!

5
What is an adverse event?

• An incident in which unintended harm resulted to
  a person receiving health care
• Has to be caused by health care rather than the
  primary illness/reason for health care
• What are some examples in your setting?

6
What are the barriers to improvement?

• Culture of blame drives problems underground
• Normalising bad outcomes
• Low investment in system redesign - means
  outdated, unsafe systems
• Safe and effective staffing - health lags behind
  other industries
• Lack of useful measurement feedback for health
  professionals

7
How to reduce risks?

• Safe, evidence-based practice
• Guidelines and protocols
• Record keeping and documentation
• Maintaining confidentiality
• Communication - staff to patients and between
  staff
• Ensuring that all staff learn from critical
  incidents and 'near misses
• Keeping a record of adverse events and learning
  from them, both individually and collectively

8
Five Cs of Risk Reduction

• Compassion genuine care, enable informed
  choices, share concerns
• Communication quality time, good explanations a
  share uncertainty. Good communication with
  colleagues, effective collaborative systems
• Competence know your ability
• Charting adequate documentation dated, timed,
  complete, contemporaneous, accurate and objective
• Confession extreme honesty reduces complaints
  and increases consumer satisfaction Open
  Disclosure

ALSO, 2000
9
What is evidence based practice?

• The judicious use of the best evidence available
  so that the clinician and the patient arrive at
  the best decision, taking into account the needs
  and values of the individual patient Sacke
  tt et al 2000

10
Where to find evidence?

• Some examples
• WHO Reproductive Health Library
• Cochrane Library
• Medline/CINAHL
• HINARI

11
Levels of Evidence

• Why would we want to have levels of evidence?
• I systematic review of all relevant RCTs
• II at least one properly designed RCT
• III-1 well-designed RCT that uses alternate
  allocation or some other method
• III-2 comparative studies, case control studies
• IV case series, opinions from respected
  authorities, descriptive studies, reports from
  expert committees
• Source NHMRC, 1998

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Getting evidence into practice

• There are three steps to getting research
  evidence into practice 1. finding the evidence
  2. understanding the evidence 3. implementing
  the new evidence to improve the quality of care

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Learning from Adverse Events

• What are some of the ways we can learn from
  adverse events?
• What systems do you have in your country?

14
Change the System not the people

• Remember - Every system is perfectly designed to
  achieve the results that it achieves