1. THE CONCEPT OF CLINICAL AUDITS IN OBSTETRIC CARE

2. I. BACKGROUND: Clinical audit 1. A quality improvement process 2. Goal: To improve patient care and outcomes through systematic assessment of practice against a defined standard, with a view to recommending and implementing measures to address specific deficiencies in care.

3. I. BACKGROUND: Clinical audit in obstetric care It also implies the retrospective critical review of clinically undesirable pregnancy related events

4. II. AREAS FOR CLINICAL AUDIT  Maternal and perinatal deaths - common  The near misses - maternal survivors of fatal morbidity.  Routine clinical practices against evidence based standards Partogram use in labur, Referral norms.

5. III. WHY CONDUCT AN AUDIT? 1. Improve clinical care and outcome 2. Enhance rational use of limited resources Thro rejection of less useful and implement useful interventions. E.g. episiotomies, CS vs vacuum 3. Improve staff morale and motivation Criterion based audit provides significant educational value Involves provision of feedback on the quality of performance → improves performance, motivation

6. IV. MATERNAL/PERINATAL MORTALITY AUDITS - OBJECTIVES 1. To determine the primary and final causes of death, 2. To identify mismanagement (preventable factors and missed opportunities). 3. To ascertain how to improve future management.

7. V. PREVENTABLE FACTORS 1.Health worker related: Where a health provider did not do something which had a direct influence on the maternal/perinatal death.  e.g. failure to institute appropriate and timely treatment 2.Administrative related: Where something that is the responsibility of the health authority was not available.  e.g. equips, drugs & supplies

8. V. PREVENTABLE FACTORS cont 3.Patient related: Where a woman by not doing something contributed to her death. e.g. delay to come to the HF

9. VI. EFFECTIVE MATERNAL/ PERINATAL MORTALITY AUDIT A cycle that consists of:  Identifying cases,  Collecting information,  Analysing the results,  Formulating recommendations,  Implementing change and  Re-evaluating practice, and this cycle must be repeated regularly

10. PRACTICE IN THE ABSENCE OF AUDIT  Denies health staff information about their strength and weaknesses in their patient care activities and therefore;  Failure to improve care.

11. Proposed Members of the Perinatal Mortality Audit Team: Tanzanian Guideline 1. Health facility in-charge 2. Matron 3. Doctors in Obstetric department 4. Nurse incharge - labour ward, neonatal unit 5. Representatives from the pharmacy, theatre 6. Head - laboratory 7. DMO 8. District RCH coordinator 9. DNO