COLOR CODING SYSTEM

AT PRIMARY HEALTH CARE SYSTEM

IN MALAYSIA
Hudayah binti Yahaya 101303125 group B1

colour coding system

disadvantage

advantage

Introduction
The risk approach system using colour codes. Implemented in Malaysia since 1989 and revised in 1991. It grades all antenatal mothers according to the level of severity of risk factors.

Aims
To enable the rural health staffs to differentiate between cases they could continue to see and those that should be referred to refer cases to the appropriate level of care without delay To ensure appropriate category of staffs treats the case without delay
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How it works?
Mother come for antenatal check up

Grades mother according to the level of severity of risk factors

self-adhesive colour tag was placed on the upper right hand corner of the mother's antenatal card

The color codes

colour place of care officer responsible specialist medical officer (o n g) medical officer place of delivery

Red

hospital

hospital

Yellow

hospital/ health center health centre

hospital

Green

house officer nurse community nurse community nurse

hospital

health centre

abc home
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White code
White code 1 Mothers have to deliver in hospital
Criteria: 1) Primigravida 2) Age < 18 years or > 40 years 3) Spacing < 2 years or > 5 years 4) Gravida 6 and above 5) Height < 145cm 6) Home surrounding not suitable 7) Single mother
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 White code 2 Mothers are not at risk for any complications Allowed to deliver at home Criteria:
1) Gravida 2 to 5 2) No past obstetric problem 3) No past medical problem 4) Home environment is good 5) Height > 145cm 6) Baby weight >2kg, <3.5kg 7) >18 years or <40 years 8) Married with family support 9) Period of gestation >37 weeks or <41 weeks 10) baby's weight > 2kg and < 3.5 kg
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Green Code
Mothers have risk that may complicate the pregnancy Antenatal care is monitored by medical and health officer Criteria: 1. Rh negative 2. Weight before pregnancy/during booking <45kg 3. Weight > 80kg during booking 4. Medical problem: psychiatric/physical illness except diabetes and hypertension

5. Past gynaecological problem/operation

6. Smoking, alcohol, drug addicts 7. Unsure LMP 8. Recurrent abortion 9. Past obstetric history of : LSCS , PIH , eclampsia , diabetes , 3rd degree perineal tear , placenta accreta , PPH , Instrumental delivery , prolong labour pain 10. More than 1 fetus 11. BP 140/90 mmHg without proteinuria 12. Disproportionate SFH
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Yellow code
Mothers have to be monitored regularly on basis If there is further complication, the mother is tagged red and will be hospitalised. Refer to specialist/OBG hospital or clinic within 48 hours

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 Criteria: Mother with HIV + Mother with HepB + Blood pressure > 140/90 mmHg or <160/110 mmHg with no proteinuria Mothers with diabetes Fetal movement is decreased at > 32 weeks of pregnancy Post term > 7 days of EDD Hb <9g/dl
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Red zone
Indicates that mothers are at a very high risk and to be hospitalised immediately Criteria: Pre-eclampsia (high BP with albuminuria) or has symptoms of BP > 160/110 mmHg Eclampsia Ischemic heart disease during pregnancy with sign and symptoms (Shortness of 13 breath/palpitation)

Shortness of breath while doing mild activity. Uncontrolled diabetes with presence of ketone in urine (>+1) Bleeding per vagina during pregnancy (including abortion) Abnormal fetal heart rate : FHR < 110/min during or after 26 weeks FHR > 160/min after 34 weeks
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Anemia with symptoms Premature contraction Rupture of membrane without contraction Severe asthmatic attack

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Advantages
Appropriate measures taken without delay Appropriate distribution of health staff Involvement of family members, community and health personnel in combating maternal/ infant mortality and morbidity Provides health education, information and motivational programme.
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Disadvantages
Can cause psychological stress to the patient Not accurate (error in classifying)
*Studies done in 1997 by Department of Comunity Health, UKM showed only 56% of the assigned codes were accurate.

Need to train nursing personnel High maintenance and inconvinience Requires full commitment from all to succeed
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Reference
Did We Do it Right? An Evaluation of the Colour Coding System for Antenatal Care in Malaysia, J Ravindran, FRCOG*, K Shamsuddin, Dr PH** , S Selvara;u, DPH***, 'Department of Obstetrics & Gynaecology, Seremban Hospital, 70300 Seremban, Malaysia, **Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, "'Family Health Division, Ministry of Health,Kuala Lumpur Inovasi Keibuan Selamat 1998 Sistem tali berwarna pada kad antenatal kes berisiko, pejabat kesihatan Sik Kedah Darulaman.

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