Colombian nurses improve the quality of care at birth

December 2015

A pregnant woman is examined with a group observing, Colombia.
PAHO/WHO

In the maternity ward at Hospital La Victoria Sede II in Bogota, Colombia, a pregnant mother is admitted complaining of stomach pains and a severe headache. Her blood pressure is elevated and her face and hands have begun to swell.

Head nurse Ana Celia García recognizes the symptoms of pre-eclampsia – one of the leading causes of maternal mortality in Colombia, and a condition she commonly sees in the maternity ward. She wants to ensure effective safe care for the mother.

Ana knows what to do. She refers to the WHO Safe Childbirth Checklist, attached to the patient’s medical chart, and follows every step to provide the mother and her baby the safest care possible.

As she scans through the checklist, she stops at the question: “Does the mother need to start magnesium sulfate and antihypertensive treatment?” Ana checks the box: “Yes, magnesium sulfate given,” and moves down the list of life-saving interventions.

A simple checklist

In June 2014, as part of a patient safety initiative, the Colombian Society of Anaesthesiology joined WHO’s Safe Childbirth Checklist Collaboration to field test the pilot checklist’s usability in 3 facilities in Colombia: Hospital La Victoria Sede II, Clínica El Prado, and Hospital San José de Buga.

Utilizing WHO’s existing evidence-based guidelines and recommendations, the 29-item checklist was developed to address the major causes of maternal and neonatal deaths, including haemorrhage, infection, obstructed labour, preeclampsia and birth asphyxia.

“One of the most important things about the Safe Childbirth Checklist are the tips that alert us about the mother´s safety. When we check the sequence of steps with the patient, we are reducing the risk of error and reminding ourselves of all the steps needed to ensure a safe birth for both the mother and baby.”

Ana Celia García, Head Nurse, Hospital La Victoria Sede II, Bogota, Colombia

As part of the field testing, 142 Colombian nurses were trained to use the checklist, which was developed in partnership with Harvard T.H. Chan School of Public Health and health practitioners and patients around the world. In just less than a year since implementation, Ana says it is already improving safety and quality of care in Hospital La Victoria Sede II, where more than 3800 babies are born each year.

“One of the most important things about the Safe Childbirth Checklist are the tips that alert us about the mother´s safety,” says Ana. “When we check the sequence of steps with the patient, we are reducing the risk of error and reminding ourselves of all the steps needed to ensure a safe birth for both the mother and baby.”

“The implementation of the Checklist has helped us to have better control of our practices and to properly monitor patient safety,” she says. “Our success in implementation can be observed in the reduction of adverse events and the empowerment of health workers in our facility.”

Reducing maternal and neonatal complications worldwide

Every day, approximately 830 women worldwide die from preventable causes related to pregnancy and childbirth. A substantive fraction of these deaths could be prevented by implementing simple and well-known health-care practices, like taking a patient’s blood pressure and taking the correct actions if the blood pressure is high.

However, in many settings poor infrastructure, limited staff resources and competing priorities reduce the quality of care for many pregnant women and many physicians and nurses miss important live-saving steps.

To combat this issue, WHO developed the Pilot Edition of the WHO Safe Childbirth Checklist and field-tested it in more than 34 global projects from 2012-2015 to ensure its viability and practical use.

“The WHO Safe Childbirth Checklist Collaboration allowed us to learn about the use of the Checklist in diverse settings around the world, including low, middle and high income countries. This helped us to better understand the practical aspect of its feasibility,” says Dr Sepideh Bagheri Nejad, Technical Officer in WHO Service Delivery and Safety Department.

Since 2012, WHO has also been supporting a randomized controlled trial called BetterBirth in more than 100 hospitals in India, to test the effectiveness of the checklist in improving health outcomes for mothers and infants. This study will be completed in 2017.

The experiences of the BetterBirth trial and the field-testing exercise provide the basis for the WHO Safe Childbirth Checklist Implementation Guide. The Implementation Guide and Checklist have been published for worldwide use and are currently being translated into other languages.