Improving Maternal Morbidity and Mortality Rates

Introduction

Quality of care is an integral component of equity, dignity, and the right to medical care to children and women. As nurses, it is our mandate to make sure that all patients get quality care without discrimination or prejudice. In 2016, the World Health Organization (WHO) published standards to be adopted by healthcare facilities in improving maternal and newborn care (World Health Organization, 2017). The standards emphasize the significance of nurses in improving care and patient satisfaction due to improved healthcare outcomes.

Clinical Problem

My measurable patient-centred practice problem involves an increased number of maternal complications, care of sick newborns cases and mortality rates reported in the within our health facility. Most of the cases are usually from our internal maternity department, while very few are referred from other facilities. Despite the increased global coverage on reducing stillbirths, maternal and newborn mortality, and afterbirth complications to mothers and newborns, it seems we still have some inadequacies in our maternity or ER department. Such shortcomings lead to increased levels of the reported cases of emergency care to mothers, newborns, or expectant mothers, which signal gaps in our healthcare processes. Our emergency department and the maternity department need to improve quality of care processes so that mothers and newborns can receive urgent care whenever they need it.

Most facilities struggle to provide emergency medical care required to manage maternal care complications, sick and premature newborns (Howell & Zeitlin, 2017). After meeting with our nurse supervisor to discuss the problem, we realized that our ER was receiving about five to ten cases of maternal complications, sick newborn, or premature births per day. These numbers are relatively high compared to the past data and the overall rate of maternity admissions. As a result, it is difficult sometimes to establish several reasons that we believe could be causing the problem. After brainstorming, among the potential factor identified as possible reasons for the increased maternal and newborns seeking emergency care include; lack of motivated, competent staff, poor or lack of adequate and effective medication, lack of compliance to EBP interventions, improper documentation, and application of patient information, poor hygiene or infrastructure related issues(Kearns et al., 2016).

Analysis of Existing Evidence

The World Health Organization (WHO) standards emphasize the significance of nurses in improving care and patient satisfaction due to improved healthcare outcomes. The desired patient outcomes here include a reduction in maternal complications, morbidity and mortality rate reported in our facilities. These desired patient outcomes also represent the measurement criteria for gauging the quality of care at our maternity department.

Literature Review

Measuring the quality of care offered in a facility can be influenced by a number of factors. Systems failures within and outside the facility can contribute to an increase in maternal complications, morbidity and mortality rates. As noted by Howell & Zeitlin (2017), high-quality health care can play a significant role in reducing adverse maternal outcomes. The author notes that the rates of morbidity and mortality depend on factors such as;

• Structural characteristics of the facility, including personnel qualifications and hospital attributes like equipment and capacity.
• Organizational factors like leadership, culture, audit, communication, feedback and EBP promotion
• Clinical processes that include the use of EBP, patient safety and the quality of care

According to Howell & Zeitlin (2017), government departments and professional institutions have set quality goals that determine substandard care using the above measurement indicators. Audits and case reviews, as noted by Kearns et al. (2016), indicate organizational factors and clinical processes as the leading contributors to maternal complications and deaths. Particularly, provider-related factors like delayed diagnosis, failure to diagnose, poor communication and documentation and inappropriate or delayed referrals are the highest risk factors.

Another study by Chou et al. (2016), defines and measures maternal morbidity and related child complications using a maternal morbidity matrix. The matrix considers the effect of morbidity using different health dimensions beyond the physical aspects of health to the overall well being. A morbidity matrix is, therefore, a measurement tool that is not limited to the gynaecological and obstetrical aspect of health. The measurement tool includes obstetric morbidities, intervention-related issues, mental conditions, trauma, cultural practices and other coexisting /previous conditions. The approach uses a holistic maternal near-miss approach to establish complications that are less severe during pregnancy. The approach consisted of two dimensions, 1) signs and symptoms investigation and management and 2) disability and functional impacts like the loss of social, cognitive, physical, psychological and economic functions (Chou et al., 2016).

Quality Improvement Process

An increased number of maternal complications, care of sick newborns cases and mortality rates is a call for concern that requires urgent actions. Improving the quality of service delivery is, therefore, critical in improving maternal morbidity and mortality rates (Howell & Zeitlin, 2017). This is something that cannot happen overnight; hence, it requires careful planning and execution and needs total collaboration among the relevant teams. The Plan – Do – Study – Act (PDSA) is a quality improvement model that is efficient and iterative in learning and trial approach to develop, test and learn from change ideas (Spath, 2018). The model literally starts with a plan and ends with an action that is executed by applying what is learned through the whole process. The model is a cycle, and multiple cycles could be needed to establish the desired change.

To achieve the desired change in the reduction of morbidity and mortality rates, I will apply the PDSA model of quality improvement. Besides PDSA acts a method of testing the change idea being implemented (Spath, 2018). It requires a breakdown to the four-stage approach into steps that allow continuous evaluation of outcomes, improvement and testing.

Plan – This process requires analyzing the care process to establish the gaps to be prioritized.

Do – The plan developed above will be auctioned on to determine whether the desired change is being achieved.

Study – The improvement process here entails observing the process of implementation and noting down the changes that are improving the process, curtailing the process or reducing morbidity and mortality. Necessary changes are made on the original plan based on what has been learned.

Action – Positive improvements will be noted and implemented at this stage and carried forward in the next PDSA cycle. The strategies that didn’t work will be reviewed, and the necessary changes tested and implemented in the next cycle.

Conclusion

In summary, the quality of care for newborns and mother, depending on the appropriateness and timeliness of nurse interventions in bringing the outcome desired by newborns, mothers and their families. The two main characteristics of care exhibited here include the quality of care provided and the quality of care as perceived by mothers, newborns, and families. In resolving the issues arising in our facility, it is integral to improve the quality of care to mothers and newborns. Various models and tolls have been applied to improving the quality of care. To achieve the desired change in the reduction of morbidity and mortality rates, the PDSA model will be applied testing the change ideas being implemented.

Reference

Chou, D., Tunçalp, Ö., Firoz, T., Barreix, M., Filippi, V., von Dadelszen, P., … & Maternal Morbidity Working Group. (2016). Constructing maternal morbidity–towards a standard tool to measure and monitor maternal health beyond mortality. BMC pregnancy and childbirth, 16(1), 45.

Howell, E. A., & Zeitlin, J. (2017, August). Improving hospital quality to reduce disparities in severe maternal morbidity and mortality. In Seminars in perinatology (Vol. 41, No. 5, pp. 266-272). WB Saunders.

Kearns, A. D., Caglia, J. M., ten Hoope‐Bender, P., & Langer, A. (2016). Antenatal and postnatal care: a review of innovative models for improving availability, accessibility, acceptability, and quality of services in low‐resource settings. BJOG: An International Journal of Obstetrics & Gynaecology, 123(4), 540-548.

Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Chicago, IL: Health Administration Press.

World Health Organization. (2017). Managing complications in pregnancy and childbirth: a guide for midwives and doctors. World Health Organization