Improving the standards of care for women having caesarean sections.

Improvement in the uptake of prophylactic antibiotics at caesarean section was chosen as a priority at the 1994 ASQUAM (Achieving Sustainable Quality in Maternity) meeting. The interventions used were guidelines, cyclical audit of cases and a patient-specific reminder stamp in the notes. A more detailed qualitative assessment of standards of communication and outcome was undertaken on a smaller cohort of women. Data on antibiotic prophylaxis were obtained from an audit record completed for every caesarean section undertaken at North Staffordshire Hospital from 1996 to 1998. Information on morbidity following caesarean section and on counselling was obtained from a review of the case records of a consecutive series of 75 caesarean sections and from a telephone call. In the baseline audit, 75% of women had received antibiotics; this increased to 92% in the remainder of 1996, 95% in 1997 and 98% in 1998. Fifty-eight of the 75 women were contactable by telephone (77%); of these 16 (28%) had a 'wound infection', 12 of which developed after discharge from hospital. Only 25 women (43%) remembered being counselled about the caesarean section. It is possible to achieve significant improvements in the quality of care for women having caesarean sections through the use of local guidelines, cyclical audit and reminder stamps. However, this audit, with community follow-up, raises questions about the adequacy of single dose prophylaxis. It also suggests the need for improved compliance with RCOG communication following caesarean section guidelines.