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.
