OBJECTIVES When you have completed this unit you should be able to: Understand the meaning of a mortality audit. Arrange and manage a perinatal mortality meeting. Write a perinatal mortality report. Use the Perinatal Problem Identification Programme (PPIP).

COPYRIGHT

All rights reserved. No part of this Perinatal Education Programme may be altered in any way without the written permission of the editorial board of the Perinatal Education Trust. To facilitate the improvement of perinatal care, the Programme may be reproduced for teaching purposes provided due acknowledgement is given and the material is not sold for financial profit. While the advice and information in the Programme is believed to be accurate, the editorial board cannot accept responsibility or liability for any errors or omissions that may have been made.

ISBN 0 7992 2141 4

AUDIT

49-1 WHAT IS AN AUDIT?

An audit is a thorough assessment, count or evaluation. In an audit information is systematically collected and then presented in a manner that can be understood. An audit of health care can be conducted.

AN AUDIT IS A CAREFUL ASSESSMENT OF A SITUATION

49-2 WHY CONDUCT AN AUDIT OF HEALTH CARE?

With an audit it is possible to identify problems and then make plans to find solutions. It is the best way to find out what is happening in a service and why problems are occurring. If you do not know where the problems lie, it is very unlikely that you will able to solve the problems. You may not even know that there is a problem. With a clear idea of the type and extent of a problem, steps can be taken to prevent or correct the problem.

Therefore, by auditing a health service one can get a clear idea of where problems lie. This will usually point one in the direction where solutions can be found. However, an audit alone does not solve the problems. To do this requires effort and commitment.

AN AUDIT IS OFTEN THE BEST METHOD OF IDENTIFYING PROBLEMS

49-3 WHAT IS A MORTALITY AUDIT?

This is an audit of people who die. Unfortunately many women and their newborn infants still die. Death is a very definite end point for an investigation into health care. If the number of deaths can be reduced, the care of all mothers and infants who survive will also improve.

A maternal mortality audit looks at the number and causes of maternal deaths. Only women who die between conception and 6 weeks after delivery are included in a maternal mortality audit.

A perinatal mortality audit looks at stillbirths and early neonatal deaths. A stillbirth is an infant born dead and weighing 500 g or more. An early neonatal death is a death occurring in an infant during the first week of life.

BY DECREASING THE NUMBER OF MOTHERS AND INFANTS DYING, THE CARE OF ALL MOTHERS AND INFANTS WILL BE IMPROVED

The detailed definitions of maternal and perinatal deaths are given in unit 46.

49-4 WHERE AND WHEN IS A MORTALITY AUDIT OF A HEALTH CARE SERVICE CARRIED OUT?

Usually an assessment of a health care service is done within a carefully defined area over a particular period of time. It is best if a mortality audit is done in a whole health region over a one year period. This would include all the clinics and hospitals in that region. However, an audit can be made of a single clinic or hospital or a single hospital together with the attached clinics.

49-5 WHO CONDUCTS A MORTALITY AUDIT?

The responsibility for conducting an audit lies with the authority responsible for providing the service. However, everyone working in that service should be interested and involved in finding out where problems lie and in helping to find answers to those problems.

49-6 HOW IS A MORTALITY AUDIT DONE?

1. The information (data) must be collected.
2. The information must be analysed.
3. The information must be discussed and conclusions drawn.
4. Plans must be made to correct any problems which may have been detected.

49-7 WHAT IS A MORBIDITY AUDIT?

Morbidity is all the problems and illnesses which are not severe enough to cause death. Morbidity is more common than mortality, but the causes usually are the same. If mortality can be reduced, morbidity will also be less. It is important not to forget morbidity. Often morbidity is included as part of a mortality audit.

49-8 WHAT IS A MATERNAL CARE AUDIT?

This is an investigation to identify and solve problems which occur in providing care for pregnant women. A maternal care audit would include many aspects of maternal care, other than just deaths, such as the number of women who:

1. Receive antenatal care.
2. Deliver by various methods.
3. Have problems during pregnancy, delivery and the peuperium.

Once this information is collected and analysed, answers can be found to problems with maternal care.

49-9 WHAT IS A PERINATAL CARE AUDIT?

This is an audit of care given to the fetus and newborn infant. Perinatal means before, during and after birth. A perinatal care audit would include many aspects of perinatal care, such as the number of:

1. Infants born alive.
2. Males and females.
3. Infants in different birth weight categories.
4. Deaths and the causes of these deaths.

As with a maternal care audit, once this information is collected and analysed, answers can be found to problems with perinatal care.

49-10 CAN MATERNAL AND PERINATAL MORTALITY AUDITS BE COMBINED?

Yes. Maternal and perinatal care audits are often considered together as both reflect the standard of perinatal care.

In practice, maternal and perinatal audits are done in the form of perinatal mortality meetings.

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