University of Birmingham Medical School, Edgbaston, Birmingham, United Kingdom.
Institute of Applied Health Research: University of Birmingham, Birmingham Clinical Trials Unit College of Medical and Dental Sciences, Birmingham, United Kingdom.
PLoS One. 2020 Mar 6;15(3):e0230063. doi: 10.1371/journal.pone.0230063. eCollection 2020.
Women-held maternity documents are well established for enabling continuity of maternity care worldwide, with the World Health Organisation (WHO) recommending their use in effective decision-making. We aimed to assess the presence, content and completeness of women-held maternity documents at admission to hospitals in The Gambia, and investigate barriers and facilitators to their completion.
We interviewed 250 women on maternity wards of all 3 Banjul hospitals and conducted content analysis of documentation brought by women on admission for their completeness against WHO referrals criteria. Logistic regression models were used to estimate the odds of the minimum criteria being met. Two focus groups and 21 semi-structured interviews (8 doctors, 8 midwives and 5 nurses) were conducted with healthcare practitioners to explore barriers and facilitators to documented clinical information availability on admission.
Of the women admitted, all but 10/250 (4%) brought either a maternity card or a structured referral sheet. Of all forms of documentation, women most frequently brought the government-issued maternity card (235/250, 94%); 16% of cards had all 9 minimum criteria completed. Of the 79 referred women, 60% carried standardised referral forms. Only 30% of 97 high-risk women had risk-status recorded. Women were less likely to have documents complete if they were illiterate, had not attended three maternity appointments, or lived more than one hour from hospital. During qualitative interviews, three themes were identified: women as agents for transporting information and documents (e.g. remembering to bring maternity cards); role of individual healthcare professionals' actions (e.g. legibility of handwriting); system and organisational culture (e.g. standardised referral guidelines).
Women rarely forgot their maternity card, but documents brought at admission were frequently incomplete. This is a missed opportunity to enhance handover and quality of care, especially for high-risk women. National guidelines were recognised by providers as needed for good document keeping and would enhance the women-held maternity documents' contribution to improving both safety and continuity of care.
在全球范围内，女性持有分娩文件已被证明有助于实现分娩护理的连续性，世界卫生组织（WHO）建议在有效的决策中使用这些文件。我们旨在评估冈比亚医院入院时女性持有分娩文件的存在、内容和完整性，并调查其完成的障碍和促进因素。
我们对所有 3 家班珠尔医院的产科病房的 250 名妇女进行了访谈，并对入院时女性带来的文件进行了内容分析，以评估其完整性是否符合世界卫生组织转诊标准。使用逻辑回归模型估计满足最低标准的可能性。我们还与医疗保健从业者进行了 2 个焦点小组和 21 次半结构化访谈（8 名医生、8 名助产士和 5 名护士），以探讨入院时记录临床信息的障碍和促进因素。
在入院的妇女中，除了 10/250（4%）名妇女外，所有人都带来了产妇卡或结构化转诊表。在所有形式的文件中，妇女最常带来政府颁发的产妇卡（235/250，94%）；16%的卡片填写了所有 9 项最低标准。在 79 名被转诊的妇女中，60%携带了标准转诊表。只有 30%的 97 名高危妇女记录了风险状况。如果妇女是文盲、没有参加过三次分娩预约或距离医院超过 1 小时，那么她们的文件就不太可能完整。在定性访谈中，确定了三个主题：妇女作为运输信息和文件的代理人（例如，记得携带产妇卡）；个体医疗保健专业人员的行动的作用（例如，手写的清晰度）；系统和组织文化（例如，标准化转诊指南）。
妇女很少忘记她们的产妇卡，但入院时带来的文件往往不完整。这是一个错失的机会，可以加强交接和护理质量，特别是对高危妇女而言。提供者承认国家指南是保持良好文件记录所必需的，并将增强女性持有的分娩文件对提高安全性和护理连续性的贡献。
