Safety and quality in maternal and neonatal care: the introduction of the modified WHO Safe Childbirth Checklist

Abstract

Maternal and neonatal mortality and morbidity associated with childbirth is a problem of the highest priority. This research has been aimed at testing a modified version of the WHO Safe Childbirth Checklist in one Italian hospital and to evaluate the tool in terms of its impact on clinical practice and safety. Results show that the presence of correctly compiled partogram tool is strongly and significantly associated with the checklist implementation (OR = 14.9, 95% confidence interval [CI] = 3.5, 63.9). Compliance to the checklist was high for mid-wives (96%) and very low for obstetricians (3%). The discrepancy is the result of a misinterpretation by obstetricians: they signed only in case they prescribed therapy or when they identified risk factors, but not to underline that they checked for those factors independently by their existence. While the checklist promotes the interdisciplinary work, field studies generally show strong hierarchical rather than partnership interaction.

Practitioner Summary: The study is aimed at evaluating: the checklist impact on clinical practice through a prospective pre- and post-intervention study based on clinical records review, the usability of the tool and the user’s compliance. The research gives evidences on the importance of the tool for reducing risks related to delivery.

Keywords:

• Maternal and neonatal safety
• childbirth checklist
• users’ compliance
• risks in delivery

Acknowledgements

The authors would also like to thank: Sepideh Bagheri Nejad, MD (Technical Officer, Knowledge Management WHO Service Delivery and Safety); Giansenio Spinelli, MD (Director of Maternal and Neonatal Department of the Prato Hospital and of the Tuscany central Area Healthcare Service) and the Clinical Risk Management Unit of the Prato Hospital for their assistance during the course of this study. The authors would like to thank also the Neonatal and Maternal Department staff of the Prato Hospital for its commitment during the pilot.

Notes

1. United Nations Millennium Development Goals regions, http://huebler.blogspot.it/2006/08/millennium-development-goal-regions.html, last accessed 10 May 2017.