Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK
Taiz Houban Mother and Child Hospital, Medecins Sans Frontieres Operational Centre Amsterdam, Amsterdam, The Netherlands.
BMJ Open Qual. 2022 Dec;11(4). doi: 10.1136/bmjoq-2022-002013.
This safety improvement project used quality improvement methods in a Comprehensive Emergency Obstetric and Newborn Care facility in Yemen, managed by an international humanitarian non-governmental organisation. It is responsible for about 6500 deliveries per annum. Following a local review of maternal deaths and serious incidents in 2020-2021, care for women with severe hypertensive disease in pregnancy and postpartum haemorrhage were highlighted as potential areas for improvement. These are also the two most common reasons recorded for maternal mortality in Yemen (and in many low-income countries worldwide). We also wanted to foster an open and honest safety culture within the department that encouraged learning from error.We used an inclusive approach in designing the improvements, with change ideas collated via frontline doctors, midwives and nurses working in the maternity unit. Data were collected via manual audit, and through routinely collected data. We focused on the following measures: number of incidents reported per month, documentation quality of antihypertensive prescriptions, fluid restriction practices in women with severe pre-eclampsia, number of minutes taken to control severe hypertensive episodes, postpartum haemorrhage identification rates and tranexamic acid stock usage. We evaluated the efficacy of team simulation training through precourse and postcourse questionnaires.We found demonstrable improvement in our measures relating to treatment of women with hypertensive disorders of pregnancy, and in postpartum haemorrhage identification and treatment. Team simulation training was a difficult intervention to sustain but was received well with positive results during our test session. Incident reporting showed a temporary increase, but this effect was not sustained.We concluded that quality improvement methodology is a valuable tool even in challenged healthcare settings such as this one, in an active conflict zone. Behaviour change in team culture and safety culture is harder to sustain and demonstrate without a long-term strategy.
本安全改进项目在也门的一家综合性产科和新生儿急救机构中使用了质量改进方法，该机构由一家国际人道主义非政府组织管理。它每年负责约 6500 次分娩。在 2020-2021 年对孕产妇死亡和严重事件进行了当地审查后，发现妊娠和产后严重高血压疾病以及产后出血的护理是潜在的改进领域。这也是也门（以及全球许多低收入国家）记录的孕产妇死亡的两个最常见原因。我们还希望在部门内培养一种开放和诚实的安全文化，鼓励从错误中学习。我们采用包容性方法设计改进措施，通过在产科病房工作的一线医生、助产士和护士收集改进意见。通过手工审核和常规收集的数据收集数据。我们专注于以下措施：每月报告的事件数量、降压处方的文件质量、严重子痫前期妇女的液体限制实践、控制严重高血压发作所需的分钟数、产后出血识别率和氨甲环酸库存使用情况。我们通过课前和课后问卷评估了团队模拟培训的效果。我们发现，与治疗妊娠高血压疾病的妇女以及识别和治疗产后出血相关的措施有明显改善。团队模拟培训是一项难以持续的干预措施，但在我们的测试会议中得到了很好的反馈。事件报告显示暂时增加，但这种效果并未持续。我们的结论是，即使在像这样充满挑战的医疗保健环境中，例如在活跃的冲突地区，质量改进方法也是一种有价值的工具。没有长期战略，团队文化和安全文化中的行为改变更难维持和证明。
