Implementing the WHO Safe Childbirth Checklist modified for preterm birth: lessons learned and experiences from Kenya and Uganda.
Implementing the WHO Safe Childbirth Checklist modified for preterm birth: lessons learned and experiences from Kenya and Uganda.
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DOI：
10.1186/s12913-022-07650-x
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发表时间：
2022-03-03
影响因子：
2.8
通讯作者：
Walker D
中科院分区：
文献类型：
--
作者：
Achola KA;Kajjo D;Santos N;Butrick E;Otare C;Mubiri P;Namazzi G;Merai R;Otieno P;Waiswa P;Walker D
世界卫生组织安全分娩检查表 (SCC) 包含 29 项循证实践 (EBP)，涵盖从入院到出院的四个暂停点。它已被证明可以增加 EBP 的吸收，并且已针对特定情况进行了定制。然而，东非关于使用 SCC 改善产时护理的研究很少，特别是对于早产，尽管它带来了负担。我们描述了清单调整、用户可接受性、实施和经验教训。东非早产倡议 (PTBi EA) 修改了 SCC，以便在肯尼亚西部和乌干达东部的 23 个设施中使用，这是一项整群随机对照试验的一部分，该试验评估了一系列基于设施的干预措施，以改善早产结局。针对早产儿的改良 SCC (mSCC) 包括： 在入院前添加分诊暂停点；重点关注胎龄评估、早产识别和管理；并与国家指导方针保持一致。引入后，乌干达和肯尼亚的实施分别持续了 24 和 34 个月，并通过所有地点的补充指导和数据强化得到了支持。 PRONTO® 模拟培训和质量改进 (QI) 活动进一步支持 mSCC 仅在干预设施中使用。本次分析采用了混合方法，包括清单监控、提供商调查和深入访谈。肯尼亚和乌干达分别评估了总计 19,443 份和 2229 份清单。在这两个国家，分诊和入院暂停点的完成率最高。肯尼亚所有暂停点的完成率均超过 70%；乌干达的比例为 39% 至 75%。暴露于 PRONTO 和 QI 的干预设施的完成率高于对照站点。提供者的看法引用了检查表的临床实用性，特别是在集成到患者图表中时。然而，一些人认为它重复了其他文档工具中的信息。工作量和人员配置问题阻碍了项目的完成。本研究强调了适应、迭代修改和补充活动以加强 SCC 使用的可行性和重要性。通过添加针对不同环境需求的特定提示，有重要的机会来提高其临床实用性。评估 PTBi EA 干预方案的试验已在 ClinicalTrials.gov NCT03112018 上注册，注册时间为 2016 年 12 月，为回顾性注册。在线版本包含可在 10.1186/s12913-022-07650-x 获取的补充材料。
The WHO Safe Childbirth Checklist (SCC) contains 29 evidence-based practices (EBPs) across four pause points spanning admission to discharge. It has been shown to increase EBP uptake and has been tailored to specific contexts. However, little research has been conducted in East Africa on use of the SCC to improve intrapartum care, particularly for preterm birth despite its burden. We describe checklist adaptation, user acceptability, implementation and lessons learned. The East Africa Preterm Birth Initiative (PTBi EA) modified the SCC for use in 23 facilities in Western Kenya and Eastern Uganda as part of a cluster randomized controlled trial evaluating a package of facility-based interventions to improve preterm birth outcomes. The modified SCC (mSCC) for prematurity included: addition of a triage pause point before admission; focus on gestational age assessment, identification and management of preterm labour; and alignment with national guidelines. Following introduction, implementation lasted 24 and 34 months in Uganda and Kenya respectively and was supported through complementary mentoring and data strengthening at all sites. PRONTO® simulation training and quality improvement (QI) activities further supported mSCC use at intervention facilities only. A mixed methods approach, including checklist monitoring, provider surveys and in-depth interviews, was used in this analysis. A total of 19,443 and 2229 checklists were assessed in Kenya and Uganda, respectively. In both countries, triage and admission pause points had the highest rates of completion. Kenya’s completion was greater than 70% for all pause points; Uganda ranged from 39 to 75%. Intervention facilities exposed to PRONTO and QI had higher completion rates than control sites. Provider perceptions cited clinical utility of the checklist, particularly when integrated into patient charts. However, some felt it repeated information in other documentation tools. Completion was hindered by workload and staffing issues. This study highlights the feasibility and importance of adaptation, iterative modification and complementary activities to reinforce SCC use. There are important opportunities to improve its clinical utility by the addition of prompts specific to the needs of different contexts. The trial assessing the PTBi EA intervention package was registered at ClinicalTrials.gov NCT03112018 Registered December 2016, retrospectively registered. The online version contains supplementary material available at 10.1186/s12913-022-07650-x.
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DOI：
10.1016/s0140-6736(18)32203-7
发表时间：
2018-11-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2017 Causes of Death Collaborators
通讯作者：
GBD 2017 Causes of Death Collaborators
影响因子：
3.7
作者：
Spector, Jonathan M.;Agrawal, Priya;Gawande, Atul
通讯作者：
Gawande, Atul
影响因子：
158.5
作者：
Semrau, Katherine E. A.;Hirschhorn, Lisa R.;Gawande, Atul A.
通讯作者：
Gawande, Atul A.
影响因子：
3.1
作者：
Senanayake, Hemantha M.;Patabendige, Malitha;Ramachandran, Rathigashini
通讯作者：
Ramachandran, Rathigashini
DOI：
10.1016/s2214-109x(20)30232-1
发表时间：
2020-08-01
期刊：
The Lancet. Global health
影响因子：
--
作者：
Walker, Dilys;Otieno, Phelgona;Waiswa, Peter
通讯作者：
Waiswa, Peter