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SHARE DESCRIPTION 1. Aspects of Quality of Clinical Care in Labor & Delivery Stephan Brenner 2. Rationale ã Obstetric complications intra- & postpartum phase. ã Timely…

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Clinical Quality Assessment in Nursing Care homes (/clinicalquality-assessment-innursing-care-homes) Clinical Quality Workgroup Update Jim Walker MD, Chair (/clinical-quality-workgroupupdate-jim-walker-md-chair) Clinical Quality Workgroup Report (/clinical-qualityworkgroup-report) ADAP Clinical Quality Management Tutorial Two: How to Develop an ADAP Quality Management Plan (/adap-clinical-qualityClinical Quality Framework management-tutorial-two-how(/clinical-quality-framework) to-develop-an-adap-qualitymanagement-plan) Accountable Care Clinical Quality Measures Subgroup (/accountable-care-clinicalquality-measures-subgroup) HIT Standards Committee Clinical Quality Workgroup and Vocabulary Task Force (/hit-standards-committeeclinical-quality-workgroup-andClinical Quality Framework vocabulary-task-force) (CQF) Update (/clinicalquality-framework-cqf-update) Clinical Quality Workgroup (/clinical-quality-workgroup)

1. Aspects of Quality of Clinical Care in Labor & Delivery Stephan Brenner 2. Rationale • Obstetric complications intra- & postpartum phase. • Timely initiation & organization of EmOC ability of SBAs to detect high-risk pregnancies. • early identification The 2nd National Pay for & prevention of obstetric complications routinely in every pregnancy. Quality of Care Performance Summit P4P and Focus: • Evidence-based routine care processes in L&D 1. 2. 3. Screening for early signs of IT: Improving Clinical Quality complications. Monitoring for signs of complications. Preparedness to timely intervene once Measures by Deploying complications occur. Integrated Tec (/the-2ndImplementing QI Validation 3. Objectives 1) Early Identification of emergencies: – Screening processes Danger national-pay-for-performanceTools for Coding and Clinical Signs, risk factor assessments, APGAR, etc. – Monitoring processes partograph, early summit-p4p-and-it-improvingQuality Improvement in postpartum observation 2) Prevention of emergencies: – Infection maternal/neonatal clinical-quality-measures-byAcademic Medical Centers sepsis – Hemorrhage AMSTL 3) Preparedness in emergencies: – Anticipation of need for View more... (/search/Rbf+clinical+quality) deploying-integrated-tec) (/implementing-qi-validationneonatal resuscitation tools-for-coding-and-clinical4. Methods • Observational checklists: – Routine processes performed by providers quality-improvement-inADVERTISEMENTS during labor & delivery care – Basic equipment, supplies related routine labor & delivery academic-medical-centers) care – Information on facility type • Sampling: – Convenience samples • Analysis: – Descriptive summary of frequencies of performed routine processes – Composed scores 5. Distribution of Observations Facility level Balaka District Dedza Mchinji Ntcheu Total BEmOC 11 10 14 10 45 CEmOC 10 8 5 14 37 21 18 19 24 82 Total 6. Screening: Initial assessment Danger Signs & risk factors (Hx) BEmOC 35 (n = 33) 30 32.5 25 27.5 24.24 21.21 21.21 15 20 20 10 12.12 9.091 7.5 6.061 5 6.061 5 2.5 0 ______________________________ Max score: 8 CEmOC (n = 40) 5 Percent Score components: • Vaginal bleeding • Abdominal pain • Breathing difficulties • Fever • Headache • Convulsions • HTN • Diabetes 0 1 2 3 4 5 6 7 8 0 1 2 3 4 5 6 7 8 ScreenScore4 Graphs by facility type • Only approx. 7% of cases assessed for all 8 medical history components. • About 1/4 of cases no history on risk factors or Danger Signs was obtained. • Most commonly asssessed risk factors: „vaginal bleeding“ (62%) and „abd. pain“ (51%). 7. Screening: Initial assessment vital signs (PE) 35 BEmOC CEmOC (n = 35) (n = 31) 32.26 30 31.43 25 25.71 22.58 20 19.35 17.14 15 Percent Score components: • Pulse • BP • RR • Temp • FHR 16.13 14.29 Max score: 5 10 ______________________________ 6.452 5.714 5 5.714 0 3.226 0 1 2 3 4 5 0 1 2 3 4 ScreenScore1 Graphs by facility type • • • • In about 5% of all cases no vital signs taken during initial assessment. In only about 18% of RELATED SEARCH cases all 5 vital sign parameters were assessed. Most commonly performed assessment was “fetal heart rate” (94%) least commonly performed assessment was “respiratory rate” Quality of Clinical Practice Clinical Trial Clinical Psychology Quality Of Service (/search/quality+of+clinical+practice) (/search/clinical+trial) (/search/clinical+psychology) (/search/quality+of+service) (27%) 5 Clinical Medicine Clinical Pathology Quality Of Life Quality Management System 8. Screening: Focused assessment of Newborn (PE) 90 (n = 40) (n = 35) 80 CEmOC (/search/clinical+medicine) (/search/clinical+pathology) (/search/quality+of+life) (/search/quality+management+system) 85.71 50 60 70 75.61 10 20 30 Max score: 4 BEmOC 40 Quality Management Quality Assurance (/search/quality+management) (/search/quality+assurance) ______________________________ Percent Score components: • APGAR 1 min • APGAR 5 min • Temp • weight 7.317 8.571 5.714 4.878 0 2.439 9.756 0 1 2 3 4 0 1 2 3 4 ScreenScore7 Graphs by facility type • Only 10% / 6% of cases assessed for all 4 components. • Approx. 80% of cases assessed for 3 components most commonly omitted assessment was “Temperature check” (8%) © 2017 SlideDoc.Us. All rights reserved. About (/site/about.html) Donations (/site/donate.html) 9. Vital signs vs. Equipment availability Blood Pressure: • In 58% cases without initial BP check a functional BPcuff and stethoscope available. Heart and Respiratory Rates: • In 89% Terms (/site/terms.html) DMCA (/site/DCMA.html) cases without initial pulse check, and • in 93% cases without initial respiratory rate check a functional clock/watch available. Body temperature: • In 90% maternal (93% neonatal) Contact (/site/contact.html) RSS Feed (/rss/lastest) cases without initial temperature check a functional thermometer available. 10. Prevention: Partograph documentation (S1L) Partograph used in only 67% / 76% of cases 60 CEmOC (n = 30) (n = 28) 50 53.57 30 40 43.33 20 20 16.67 14.29 13.33 10 ______________________________ BEmOC Percent Score components: • FHR Q 30 min