Evaluating Organizational Change

Evaluating Organizational Change
Despite significant progress in the management of pregnant women and children today, there is still a high burden of mortality and morbidity among the population. The problem is caused by a lack of essential diagnostic and treatment equipment in many facilities as well as a lack of clear guidelines on safe delivery and child care. It is estimated that 2.7 million newborns and 303 000 women died in 2015 around the time of pregnancy and delivery (World Health Organization (WHO), 2020). Middle and low-income countries are more affected by this challenge because they have limited resources to manage pregnant women and children. Due to the challenge of mortality and morbidity among pregnant women and children, the World Health Organization developed the safe childbirth checklist to guide delivery right from the admission of the mother to discharge. This paper discusses the implementation of the WHO safe delivery guideline in my organization and how interprofessional collaboration is achieved using the set guidelines.

Overview of Healthcare System Practice Guideline

The global commitment to reduce maternal and infant mortality has largely focused on reducing the direct causes of pregnancy-related deaths. Much focus has been put to increase the availability of skilled healthcare workers ready to work collaboratively to improve safe care delivery practices. Research demonstrates that the majority of maternal and infant deaths occur in low-resource settings and most could be prevented (Doria et al., 2019). In response to this unacceptable situation, the WHO Safe Childbirth Checklist has been developed to support the delivery of essential maternal and perinatal care practices. This checklist addresses direct issues related to delivery including an admission of the mother to the labor ward, just before pushing or before cesarean section, within one hour after birth, and healthcare practices before discharge (Perry et al., 2017). These guidelines are not developed for a specific healthcare team but rather addresses nurses, doctors, managers, and subordinate staff that work to ensure safe delivery.

The first section of the guidelines requires an assessment of the mother on admission. This assessment entails checking if the mother needs referral services depending on the facility’s criteria and starting of a partograph. Additionally, healthcare providers should check if the mother requires antibiotics or the use of anti-hypertensives for those with high blood pressure. The guideline also recommends healthcare practitioners to encourage partners to be present during childbirth and the availability of protective equipment during the process (WHO, 2020). The second aspect of the guidelines addresses the period just before the second stage or before cesarean delivery. The guidelines recommend for assessment of the need for antibiotics or magnesium sulfate. Secondly, nurses should confirm the availability of essential supplies at the bedside and prepare for delivery including the availability of an assistant.

The WHO safe delivery checklist addresses the third stage of labor to be the most important part in the prevention of maternal and infant mortality and morbidity. According to the guidelines, the healthcare practitioner should assess for abnormal bleeding, the need for starting on antibiotics, the need for referral or antibiotics commencement for the baby, and the initiation of skin-to-skin contact (WHO, 2020). Various aspects are addressed under each criterion and the WHO recommends decision making depending on the organizational policies and procedures. Lastly, the healthcare provider ought to assess for danger signs and confirm the availability of a companion or make calls when needed. The last aspect of the safe delivery checklist deals with the discharge of the mother from the hospital. It is recommended to check on the need to start antibiotics, check vital signs, check for abnormal bleeding, and baby’s well-being including breastfeeding. The guidelines also recommend the need for health education, discussion of danger signs, and initiation of a follow-up plan.

Discussion of Professional Teams

The provision of life-saving interventions alone is not enough to combat maternal and infant mortality. Efforts should be matched with the improvement of quality care using evidence-based guidelines. The healthy people 2020 initiative addresses their goal of improving the health and well-being of women, infants, children, and families through the use of collaborative approaches (Healthypeople.gov, n.d.). Interprofessional Collaboration includes working together between nurses, doctors, pharmacists, technologists, and other subordinate staff to ensure safe delivery. Clark and Davies (2018) explain that changes in nursing practice including the use of interprofessional collaboration are required in the United States to decrease maternal and infant mortality. The WHO safe childbirth guidelines are meant for all healthcare teams and require close monitoring by the managers to ensure every last aspect is followed.

Nurses are the primary care providers for pregnant women and are present more than any other healthcare team during labor and delivery. The role of nurses is addressed in every step of the four critical pause points in clinical care. The nurses are responsible for history taking during admission, checking for the need for referral, starting the partograph, and monitoring the mother throughout the first stage of labor (Clark & davies, 2018). The guidelines also hold nurses accountable for medication administration especially for high-risk mothers, initiation of breastfeeding, and active management of the mother during the third stage. The doctors are the second healthcare teams bound to the WHO guidelines on safe delivery. They are responsible for assessing the mother for referral services, initiation of antibiotics according to the set guidelines, and making critical decisions such as the need for cesarean section.

In obstetrics, interprofessional collaboration is essential for patient safety (Romijn et al., 2018). Collaborative care increases patient safety through enhanced communication and effective delivery of services including reduced errors. The WHO safe childbirth guidelines demonstrate collaboration between nurses, doctors, pharmacists, and lab technicians. The pharmacy team should ensure the availability of essential drugs such as magnesium sulfate for the management of eclampsia. The lab technicians are available to provide tests during emergencies that help in making decisions such as referral or cesarean section. Other healthcare teams such as counseling staff should be present to offer psychological care in case of child loss. The guidelines require the provision of intensive health education and counseling before the discharge of the mother.

Identification of Research

The healthcare organization uses evidence from the World Health Organization to adopt the guidelines for safe childbirth. A checklist that contains the required fields is provided as a tool to guide the practice.

Reference: World Health Organization. (2015). Patient safety: WHO safe childbirth checklist. Retrieved from

https://www.who.int/patientsafety/implementation/checklists/childbirth/en/

Definition of Evidence

The WHO guidelines for safe delivery are based on the global commitment to improving maternal health. The checklist is supported by a collaboration field testing exercise conducted in 2012 around the world. A total of 34 implementation projects across 29 countries and 230 pilot studies were conducted (WHO, 2020). The feedback was systematically collected in the form of progress reports and findings indicated the checklist can be an effective tool to reduce maternal and infant mortality and morbidity.

Level of Evidence

The evidence-based practice used in the department is level 1 evidence because it involves a systematic review of evidence collected from 34 groups (WHO, 2020). The studies were conducted from November 2012 to March 2015 representing 29 countries.

Opinion on Guideline Use

The WHO safe childbirth checklist aims at ensuring proven essential maternal and perinatal care practices are performed by skilled healthcare workers. I believe the use of the WHO guideline in my unit has improved communication between nurses and physicians during clinical care. Nurses have embraced the use of the checklist because it has reduced the number of complications during and after delivery. However, it becomes difficult to follow the checklist for every patient given the number of mothers seeking healthcare services in the facility. I believe the checklist has helped to solve issues related to admission and discharge of the patient. Secondly, doctors are also improving their practice by following the checklist especially on the initiation of drugs and making decisions on cesarean section delivery. Other teams in the department that have demonstrated well-use of the guidelines include the nursing educators and counselors especially on delivery of discharge information and initiation of follow-up plans.

Conclusion

The WHO safe childbirth checklist provides an opportunity for healthcare professionals to work collaboratively to reduce maternal and infant mortality and morbidity. The guidelines target four critical pause points in clinical care including the admission of the mother, just before delivery or cesarean section, soon after birth, and before discharge. The guidelines provide an opportunity for multidisciplinary care which improves patient safety. Based on the level of evidence supporting the development of the guidelines, healthcare organizations can greatly reduce maternal and infant mortality by implementing the guidelines in their institutions.

References

Clark, R., & Davies, L. (2018). Interprofessional collaboration helps implement an early warning system to improve maternal outcomes. Journal of Obstetric, Gynecologic & Neonatal Nursing47(3), S29-S30.

https://doi.org/10.1016/j.jogn.2018.04.058

Doria, S., Diba, F., Susanti, S. S., Vollmer, S., & Monfared, I. G. (2019). Mothers’ experiences of quality of care and potential benefits of implementing the WHO safe childbirth checklist: A case study of Aceh Indonesia. BMC Pregnancy And Childbirth19(1), 461. https://doi.org/10.1186/s12884-019-2625-8

HealthyPeople.gov. (n.d.). Maternal, infant, and child health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health

Perry, W., Bagheri Nejad, S., Tuomisto, K., Kara, N., Roos, N., Dilip, T. R., Hirschhorn, L. R., Larizgoitia, I., Semrau, K., Mathai, M., & Dhingra-Kumar, N. (2017). Implementing the WHO Safe Childbirth Checklist: Lessons from a global collaboration. BMJ Global Health2(3), e000241.

https://doi.org/10.1136/bmjgh-2016-000241

Romijn, A., Teunissen, P. W., de Bruijne, M. C., Wagner, C., & de Groot, C. (2018). Interprofessional collaboration among care professionals in obstetrical care: Are perceptions aligned?. BMJ Quality & Safety27(4), 279–286.

https://doi.org/10.1136/bmjqs-2016-006401

World Health Organization. (2020). Patient safety: WHO safe childbirth checklist. Retrieved from

https://www.who.int/patientsafety/implementation/checklists/childbirth/en/

 

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