To increase completion rate of partograph by developing guideline and supportive supervision during labor monitoring in Muhima Hospital

Abstract

Background Muhima hospital is maternal and child hospital with many deliveries. Qualified staff including midwives and physicians in the hospital manage and monitor patients’ labor progress using partograph. The incompleteness of the partograph during labor monitoring in the hospital has been raised by physicians in the meeting of maternity and during the baseline assessment, it was found 11% of partograph were incomplete. The project team analyzed the root causes and have found that the midwives were not assigned to any specific patients and the midwives did not conduct proper monitoring. This capstone reports and describes the process of identifying the root cause of the problem, the creating of the intervention and the implementation of the intervention in order to improve the completeness of partograph during labor monitoring in the hospital. Methods We conducted pre-post intervention to examine the result of the implementation of a partograph completion guidelines during labor monitoring. The total sample in pre and post intervention was 472 files. We audited 236 files in pre intervention chosen randomly from June to December 2014. After root causes analysis and selection of the intervention in March 2016 we conducted 236 files audit to examine the results of using guideline and supportive supervision during labor monitoring. Results The overall rate of completeness of partograph significantly increased from 11% to 61% with P<0.001 The results of each of the 7 components of partograph showed Fetal Heart Rate (FHR) v

increased from 77% to 89% (P<0.001), pulse from 26% to 83% (P<0.001), Blood Pressure from 36% to 80% (P<0.001), temperature increased from 19% to 65%(P<0.001), descent improved from 63% to 81% (P<0.001), dilation increased from 63% to 81% (P<0.001), and contraction increased from 28% up to 81% (P<0.001), . A total of 296 files were audited for the association of completeness of partograph with maternal, fetal mortality and Apgar score. The completion of partograph statistically decreased the percentage of fetal death from 12% to 0%, P<0.001. The percentage of babies born with higher Apgar score increased from 4.5% to 52.4% when partograph were completed, P<0.001. We could not find a statistically significant relationship between completeness of partograph and the maternal outcome (P=0.254). Conclusion and recommendation The findings showed that this hospital quality improvement project by implementing the guideline during labor monitoring including setting guideline, monitoring, and enforcing guideline significantly increased the completeness of partograph during labor monitoring at Muhima Hospital. The integrations of strategic problem solving in staff training plan in the future to build staff capacity in implementing other quality improvement projects within the hospital. Future projects may include assessing the quality of the data in partograph.