Lumala Alfred, Sekweyama Peter, Abaasa Andrew, Lwanga Humphrey, Byaruhanga Romano
Nkozi Hospital, Kampala, Uganda.
Uganda Martyrs University Mother Kevin Postgraduate Medical School, Kampala, Uganda.
BMC Pregnancy Childbirth. 2017 Jan 13;17(1):29. doi: 10.1186/s12884-016-1219-y.
The maternal mortality ratio of Uganda is still high and the leading causes of maternal mortality are postpartum haemorrhage (PPH), severe pre-eclampsia and eclampsia. Criteria-based audit (CBA) is a way of improving quality of care that has not been commonly used in low income countries. This study aimed at finding out the quality of care provided to patients with these conditions and to find out if the implementation of recommendations from the audit cycle resulted in improvement in quality of care.
This study was a CBA following a time series study design. It was done in St. Francis Hospital Nsambya and it involved assessment of adherence to standards of care for PPH, severe pre-eclampsia and eclampsia. An initial audit was done for 3 consecutive months, then findings were presented to health workers and recommendations made; we implemented the recommendations in a subsequent month and this comprised three interventions namely continuing medical education (CME), drills and displaying guidelines; a re-audit was done in the proceeding 3 consecutive months and analysis compared adherence rates of the initial audit with those of the re-audit.
Pearson Chi-Square test revealed that the adherence rates of 7 out of 10 standards of care for severe pre-eclampsia/eclampsia were statistically significantly higher in the re-audit than in the initial audit; also, the adherence rates of 3 out of 4 standards of care for PPH were statistically significantly higher in the re-audit than in the initial audit.
The giving of feedback on quality of care and the implementation of recommendations made during the CBA including CME, drills and displaying guidelines was associated with improvements in the quality of care for patients with PPH, severe pre-eclampsia and eclampsia.
乌干达的孕产妇死亡率仍然很高，孕产妇死亡的主要原因是产后出血（PPH）、重度子痫前期和子痫。基于标准的审核（CBA）是一种改善医疗服务质量的方法，在低收入国家尚未普遍使用。本研究旨在了解为患有这些疾病的患者提供的医疗服务质量，并了解审核周期中建议的实施是否导致医疗服务质量的提高。
本研究是一项采用时间序列研究设计的CBA。研究在圣弗朗西斯医院恩桑比亚进行，涉及对PPH、重度子痫前期和子痫护理标准的遵守情况进行评估。连续3个月进行初步审核，然后将结果呈现给医护人员并提出建议；我们在随后的一个月实施了这些建议，这包括三项干预措施，即继续医学教育（CME）、演练和展示指南；在接下来的连续3个月进行重新审核，并分析比较了初步审核与重新审核的遵守率。
Pearson卡方检验显示，重度子痫前期/子痫10项护理标准中的7项在重新审核中的遵守率在统计学上显著高于初步审核；此外，PPH的4项护理标准中的3项在重新审核中的遵守率在统计学上显著高于初步审核。
提供护理质量反馈以及实施CBA期间提出的建议，包括CME、演练和展示指南，与改善PPH、重度子痫前期和子痫患者的护理质量相关。
