Multifaceted Intervention to Improve the Quality of Care for Postpartum Hemorrhage
DOI:
https://doi.org/10.33192/Smj.2020.04Keywords:
Indicator; multifaceted intervention; postpartum hemorrhage; quality of careAbstract
Objective: To evaluate the effect of a multifaceted intervention on the quality of care and clinical outcomes for postpartum hemorrhage (PPH) as measured by adherence and acceptability to indicators of PPH management at district and referral levels.
Methods: A quasi-experimental study of interventions was conducted to improve healthcare for PPH in 6 district and 3 referral hospitals in southern Thailand. Multifaceted intervention included educational outreach, audit and feedback, reminders, and the involvement of an opinion leader. Physicians and nurses responsible for case management and care policies (145 individuals) in the aforementioned hospitals participated in the intervention. Medical records were reviewed considering the checklist of indicators for district and referral levels.
Results: All indicators for PPH management were accepted by at least 80% of the participants, except for surgical intervention. We reviewed the medical records of 805 women diagnosed with PPH. Of these, during the pre- and post-intervention periods, 132 and 142 were from district hospitals, and 228 and 303 from referral hospitals, respectively. The use of an indwelling bladder catheter and hemodynamic monitoring were significantly increased in the post-intervention period.
Conclusion: Quality of care for postpartum hemorrhage improved after implementing a multifaceted intervention targeting healthcare providers. The results of this study can be applied to other hospitals with a similar setting regarding the eligible criteria. Severe maternal morbidity and mortality from PPH should be monitored.
References
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25. Deneux-Tharaux C, Dupont C, Colin C, Rabilloud M, Touzet S, Lansac J, et al. Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial. Br J Obstet Gynaecol 2010; 117:1278-87.
26. Pirkle CM, Dumont A, Traoré M, Zunzunegui MV; QUARITE group. Effect of a facility-based multifaceted intervention on the quality of obstetrical care: a cluster randomized controlled trial in Mali and Senegal. BMC Pregnancy Childbirth 2013;13:24.
27. Althabe F, Mazzoni A, Cafferata ML, Gibbons L, Karolinski A, Armbruster D, et al.; Oxytocin in Uniject Study Group. Using Uniject to increase the use of prophylactic oxytocin for management of the third stage of labor in Latin America. Int J Gynecol Obstet 2011;114:184-9.
28. García-Elorrio E, Aleman A, Cafferata ML, Colomar M, Tomasso G, Lacayo Y, et al. A multifaceted intervention to increase prophylactic oxytocin use during the third stage of labor and to reduce routine episiotomies in Nicaragua. Int J Gynecol Obstet 2014; 127:31-34.
29. Gaucher L, Occelli P, Deneux-Tharaux C, Colin C, Gaucherand P, Touzet S, Dupont C. Non-clinical interventions to prevent postpartum haemorrhage and improve its management: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019;240:300-9.
30. Prasertcharoensuk W, Swadpanich U, Lumbiganon P. Accuracy of the blood loss estimation in the third stage of labor. Int J Gynecol Obstet 2000;71:69-70.
31. Schorn MN. Measurement of blood loss: review of the literature. J Midwifery Womens Health 2010;55:20-27.
2. Rossi AC, Mullin P. The etiology of maternal mortality in developed countries: a systematic review of literature. Arch Gynecol Obstet 2012;285:1499-503.
3. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066-74.
4. World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO, 2012.
5. Grol R. Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care 2001;39(8 Suppl 2):II46-54.
6. Haines A, Kuruvilla S, Borchert M. Bridging the implementation gap between knowledge and action for health. Bull World Health Organ 2004;82:724-31.
7. World Health Organization. Managing complications in pregnancy and childbirth. A guide for midwives and doctors. Geneva: WHO, 2007.
8. Lawton B, MacDonald EJ, Brown SA, Wilson L, Stanley J, Tait JD, et al. Preventability of severe acute maternal morbidity. Am J Obstet Gynecol 2014;210:557.e1-6.
9. Talungchit P, Liabsuetrakul T. Clinical audit of postpartum hemorrhage at district-level and referral-level hospitals in southern Thailand. J Med Assoc Thai 2012;95:1244-51.
10. Liabsuetrakul T, Promvijit T, Pattanapisalsak C, Silalai S, Ampawa T. A criterion-based obstetric morbidity audit in southern Thailand. Int J Gynecol Obstet 2008;103:166-71.
11. Donabedian A. Explorations in quality assessment and monitoring. Ann Arbor: Health Administration Press, 1980.
12. Wollersheim H, Hermens R, Hulscher M, Braspenning J, Ouwens M, Schouten J, et al. Clinical indicators: development and applications. Neth J Med 2007;65:15-22.
13. Campbell SM, Braspenning J, Hutchinson A, Marshall M. Research methods used in developing and applying quality indicators in primary care. Qual Saf Health Care 2002; 11:358-64.
14. Campbell SM, Kontopantelis E, Hannon K, Burke M, Barber A, Lester HE. Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework. BMC Fam Pract 2011;12:85.
15. Talungchit P, Liabsuetrakul T, Lindmark G. Development and assessment of indicators for quality of care in severe preeclampsia/eclampsia and postpartum hemorrhage. J Healthc Qual. 2013;35:22-34.
16. Smit M, Sindram SI, Woiski M, Middeldorp JM, van Roosmalen J. The development of quality indicators for the prevention and management of postpartum haemorrhage in primary midwifery care in the Netherlands. BMC Pregnancy Childbirth 2013;13:194.
17. Chaillet N, Dubé E, Dugas M, Audibert F, Tourigny C, Fraser WD, et al. Evidence-based strategies for implementing guidelines in obstetrics: a systematic review. Obstet Gynecol. 2006;108:1234-45.
18. Dupont C, Deneux-Tharaux C, Touzet S, Colin C, Bouvier-Colle MH, Lansac J, et al. Clinical audit: a useful tool for reducing severe postpartum haemorrhages? Int J Qual Health Care 2011;23:583-9.
19. Kongnyuy EJ, Mlava G, van den Broek N. Using criteria-based audit to improve the management of postpartum haemorrhage in resource limited countries: a case study of Malawi. Matern Child Health J 2009;13:873-8.
20. Audureau E, Deneux-Tharaux C, Lefèvre P, Brucato S, Morello R, Dreyfus M, et al. Practices for prevention, diagnosis and management of postpartum haemorrhage: impact of a regional multifaceted intervention. Br J Obstet Gynaecol 2009;116:1325-33.
21. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012;6:CD000259.
22. O’Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2007;4:CD000409.
23. Flodgren G, Parmelli E, Doumit G, Gattellari M, O’Brien MA, Grimshaw J, Eccles MP. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2011; 8:CD000125.
24. Liabsuetrakul T, Palanukunwong K, Chinduereh A, Oumudee N. Evaluation of a multifaceted postpartum hemorrhage- management intervention in community hospitals in Southern Thailand. Int J Gynecol Obstet 2017;139:39-44.
25. Deneux-Tharaux C, Dupont C, Colin C, Rabilloud M, Touzet S, Lansac J, et al. Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial. Br J Obstet Gynaecol 2010; 117:1278-87.
26. Pirkle CM, Dumont A, Traoré M, Zunzunegui MV; QUARITE group. Effect of a facility-based multifaceted intervention on the quality of obstetrical care: a cluster randomized controlled trial in Mali and Senegal. BMC Pregnancy Childbirth 2013;13:24.
27. Althabe F, Mazzoni A, Cafferata ML, Gibbons L, Karolinski A, Armbruster D, et al.; Oxytocin in Uniject Study Group. Using Uniject to increase the use of prophylactic oxytocin for management of the third stage of labor in Latin America. Int J Gynecol Obstet 2011;114:184-9.
28. García-Elorrio E, Aleman A, Cafferata ML, Colomar M, Tomasso G, Lacayo Y, et al. A multifaceted intervention to increase prophylactic oxytocin use during the third stage of labor and to reduce routine episiotomies in Nicaragua. Int J Gynecol Obstet 2014; 127:31-34.
29. Gaucher L, Occelli P, Deneux-Tharaux C, Colin C, Gaucherand P, Touzet S, Dupont C. Non-clinical interventions to prevent postpartum haemorrhage and improve its management: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019;240:300-9.
30. Prasertcharoensuk W, Swadpanich U, Lumbiganon P. Accuracy of the blood loss estimation in the third stage of labor. Int J Gynecol Obstet 2000;71:69-70.
31. Schorn MN. Measurement of blood loss: review of the literature. J Midwifery Womens Health 2010;55:20-27.
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Published
20-12-2019
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Liabsuetrakul, T., Lindmark, G., & Talungchit, P. (2019). Multifaceted Intervention to Improve the Quality of Care for Postpartum Hemorrhage. Siriraj Medical Journal, 72(1), 24–32. https://doi.org/10.33192/Smj.2020.04
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