USE OF CHECKLIST FOR EARLY RECOGNIZATION AND MANAGEMENT OF POST PARTUM COMPLICATIONS IN IMMEDIATE POSTPARTUM PERIOD

Background: The immediate postnatal period refers to the time just after childbirth, during which the risks to the mother of postpartum haemorrhage and other significant morbidity are highest. Close direct or indirect supervision by a skilled attendant is required in this period so that any problems can be identified promptly and appropriate intervention can be taken. Present study was conducted to assess the usefulness of patient monitoring checklist in reduction of post partum and post surgical adverse events. The objective of the present study is to decrease the adverse events in postnatal cases from 11.70 percent to 3 percent within 8 weeks time. Materials and Methods: A simple checklist was designed according to nine key components of supervision following delivery /caesarean section. Implementation of a checklist was accomplished following resident doctors and nurses training over 4 sessions. Measurement Data from all checklists used in the maternity ward were entered into a secure Microsoft Excel database. Deliveries for which a checklist was not filled out were excluded. An endline data was collected after eight weeks to assess the usefulness of checklist in prevention of postpartum adverse events. Results: The adverse event rates were 11.70% for historical controls and 2.70% for checklist cases. There was statistically significant improvement (p value <0.001) in vigilance in monitoring of the postnatal cases. Resident doctors, faculty members and hospital administrators gave a positive feedback about the usefulness of checklist for routine use in obstetric practice. Conclusion: It was found that integrating a post partum monitoring checklist, coaching and intervention with strong leadership support and adherence to QI principles of rapid cycles of change was successful in improving the delivery of quality treatment and was associated with some decline in post partum morbidity and mortality.