Improving Maternity Care through Evidence

1. Improving Maternity Care through Evidence References: ALSO Course Syllabus (2000) WHO Regional Credentialing Program Pacific EmOC Program

2. Quality in Maternity Care Doing the right thing the first time in the right way and at the right time Pacific EmOC Program

3. Essential elements of quality improvement Leadership Measurement Improvement Pacific EmOC Program

4. Why bother ….? Most health care is provided safely and appropriately … but …. sometimes things go wrong or put technically an adverse event occurs!! Pacific EmOC Program

5. What is an adverse event? An incident in which unintended harm resulted to a person receiving health care Has to be caused by health care rather than the primary illness/reason for health care What are some examples in your setting? Pacific EmOC Program

6. What are the barriers to improvement? • Culture of blame drives problems underground • “Normalising” bad outcomes • Low investment in system redesign - means outdated, unsafe systems • Safe and effective staffing - health lags behind other industries • Lack of useful measurement & feedback for health professionals Pacific EmOC Program

7. How to reduce risks? • Safe, evidence-based practice • Guidelines and protocols • Record keeping and documentation • Maintaining confidentiality • Communication - staff to ‘patients’ and between staff • Ensuring that all staff learn from critical incidents and 'near misses’ • Keeping a record of adverse events and learning from them, both individually and collectively Pacific EmOC Program

8. Five C’s of Risk Reduction • Compassion – genuine care, enable informed choices, share concerns • Communication – quality time, good explanations a share uncertainty. Good communication with colleagues, effective collaborative systems • Competence – know your ability • Charting – adequate documentation: dated, timed, complete, contemporaneous, accurate and objective • Confession – extreme honesty reduces complaints and increases consumer satisfaction – Open Disclosure ALSO, 2000 Pacific EmOC Program

9. What is evidence based practice? • “The judicious use of the best evidence available so that the clinician and the ‘patient’ arrive at the best decision, taking into account the needs and values of the individual patient” Sackett et al 2000 Pacific EmOC Program

10. Where to find evidence? • Some examples: • WHO Reproductive Health Library • Cochrane Library • Medline/CINAHL • HINARI Pacific EmOC Program

11. Levels of Evidence • Why would we want to have levels of evidence? • I systematic review of all relevant RCTs • II at least one properly designed RCT • III-1 well-designed RCT that uses alternate allocation or some other method • III-2 comparative studies, case control studies • IV case series, opinions from respected authorities, descriptive studies, reports from expert committees • Source: NHMRC, 1998 Pacific EmOC Program

12. Getting evidence into practice • There are three steps to getting research evidence into practice: 1. finding the evidence 2. understanding the evidence 3. implementing the new evidence to improve the quality of care Pacific EmOC Program

13. Learning from Adverse Events • What are some of the ways we can learn from adverse events? • What systems do you have in your country? Pacific EmOC Program

14. Change the System not the people Remember - Every system is perfectly designed to achieve the results that it achieves Pacific EmOC Program