THE CONCEPT OF CLINICAL
AUDITS IN OBSTETRIC
CARE
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.
I. BACKGROUND: Clinical audit in obstetric care
It also implies the retrospective
critical review of clinically
undesirable pregnancy related
events
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.
III. WHY CONDUCT AN AUDIT?
1.
Improve clinical care and outcome
2.
Enhance rational use of limited resources

3.
Thro rejection of less useful and implement useful
interventions. E.g. episiotomies, CS vs vacuum
Improve staff morale and motivation

Criterion based audit provides significant
educational value

Involves provision of feedback on the quality of
performance → improves performance, motivation
IV. MATERNAL/PERINATAL MORTALITY
AUDITS - OBJECTIVES
1.
2.
3.
To determine the primary and final
causes of death,
To identify mismanagement
(preventable factors and missed
opportunities).
To ascertain how to improve future
management.
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
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
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
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.
Proposed Members of the Perinatal Mortality
Audit Team: Tanzanian Guideline
1.
2.
3.
4.
5.
6.
7.
8.
9.
Health facility in-charge
Matron
Doctors in Obstetric department
Nurse incharge - labour ward, neonatal unit
Representatives from the pharmacy, theatre
Head - laboratory
DMO
District RCH coordinator
DNO