Clinical audit reveals improved use of the partogragh among midwives in Zambia



A recent Clinical audit conducted at University Teaching Hospital for Women and New- Born and Mansa General Hospital in Zambia has revealed that the number of Midwives able to use the partograph is improving, but that some midwives still do not pay attention to it.
 A partograph, which is an essential tool for decision making, is a graphical record of the observations made of a women in labour.
The audit was conducted by Lugina Africa Midwives Research Network (LAMRN) Zambia which is part of a regional LAMRN grouping aimed at improving and increasing midwifery research and evidence-based midwifery practice in the Eastern, Central and Southern African region.
      A midwife examining a pregnant women
 The clinical audit conducted at the two hospitals from 2015, to determine the level of knowledge and practices that skilled attendants had on utilization of the partograph, also revealed that utilization of the partograph is a challenge. 
 While at least 95% of midwives in labor ward are expected to be able to plot the partograph correctly, the initial audit indicated that only 7.5% of the skilled attendants were able to interpret and plot correctly on the partograph.  47.5% of the skilled attendants failed to plot on the partograph and 45% did not attempt to plot on the partograph. However, when the re-audit was conducted it revealed a significant improvement. The percentage number of the skilled attendants who were able to interpret and plot correctly on the partograph rose above the standard to 95.5 %. 
Fig1. Standard and performance gap: audit & re-audit
The initial audit further indicated that only 29.5 % of midwives monitored and recorded foetal heart every 30 minutes, 65.9% did not monitor and record foetal heart rate every 30 minutes,   while 4.6% gave Intrauterine Fetal Death (which refers to the death of a baby in the uterus, during pregnancy and before birth) as the reason for not monitoring and recording foetal heart rate every 30 minutes. When the re-audit was done however, the percentage rose to 70.5%.  
The clinical audit revealed that there are some factors that are hindering the use of the partograph among skilled attendants which include unavailability of partographs, attending to emergencies or simply no attempt to use it.   

Fig 2. Factors hindering the use of the partograph among skilled attendants
Discussing the recommendations during the audit findings dissemination meeting held in Lusaka from 23rd to 24th March 2017, the meeting endorsed the need to ensure that midwives adhere to WHO prescribed 5 year in-service training on partograph. The meeting further recommended a roll out training on partograph utilization and the need to integrate auditing in the nursing curriculum.
LAMRN plans to conduct a re-audit December 2017 and intends to integrate the audit in the 2017-2021 Ministry Of Health strategic plan so that audit is budgeted for as hospital activities.
The Clinical audit was conducted to improve quality of care by providing decision makers with evidence based practice needed to improve maternal and new-born health.




Comments

  1. Medical bill codingMarch 30, 2022 at 2:11 AM

    nice and great content

    ReplyDelete
  2. Medical bill codingMarch 30, 2022 at 2:12 AM

    Medical Coding and Audits
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