Criteria Based Audit of the Management of Severe Preeclampsia/ Eclampsia in a Nigerian Teaching Hospital
AbstractBackground: This study discusses the usage of criteria –based audit in a Nigerian teaching hospital to evaluate the quality of care among patients with severe pre-eclampsia/eclampsia (SPE-E) against set standards and proffers possible interventions in order to improve the quality of care.
Methods: The study was a prospective, descriptive hospital based study carried out from 1st of March to 31st of December, 2012. We conducted an 18 criterion-based audit on 52 consecutive cases of severe preeclampsia/
eclampsia during the study period at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria.
Results: There were 34 cases of severe pre-eclampsia and 18 eclamptic patients. The case fatality rate for SPE-E was 5.8 % and 13.5 % perinatal deaths among 59 infants delivered (multiple pregnancies inclusive). From the pre-determined standard of care based on 18 criteria, the performance score ranged from 17.3 to 100% (average 69.1%). Standard of care was optimal (100%) in taking detailed history and documentation, administering magnesium sulfate, initiating drug treatment for severe hypertension, respiratory rate monitoring and steroid treatment for fetal lung maturity and very sub-optimal for various laboratory investigations and initial consultant obstetrician input in the management of patients.
Conclusion: For improvements in maternal and perinatal outcomes for patients with SPE-E, there should be strengthening of hospital facilities and avoidance of Phase 3 treatment delays in carrying out the comprehensive emergency obstetric and neonatal care needed. Hospital leaders should also be trained in hospital management for qualitative care.
Keywords: Severe pre-eclampsia, eclampsia, criteria-based audit.
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