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