Implementação da lista de verificação para o parto seguro em uma maternidade de alto risco do Nordeste brasileiro

Abstract

Introduction: The World Health Organization (WHO) Safe Birth Checklist (SBC) is an evidence-based and low-cost tool for improving practices in caring for mothers and infants during childbirth. Due to the recent increase in maternal mortality indicators, it was important to implement and assess the effects of the WHO SBC on childbirth care in a high-risk maternity hospital in Brazil. Objectives: Implement the WHO Safe Birth Checklist (LVPS) in childbirth care in a high-risk maternity hospital in Northeast Brazil and, specifically, evaluate its effect on indicators of good practices, adverse events, and monitoring of your membership. Methodology: A quasi-experimental study was conducted where the SBC was implemented in a high-risk maternity hospital in the metropolitan region of Natal-RN. This involved adapting the SBC, training teams, evaluating safety culture, providing leadership support, and monitoring. Good practices (GP) indicators, adverse events (AE) in mothers and newborns, and adherence to the SBC were evaluated before and after the intervention using data collected through Qualiparto. Results: Data from 995 deliveries (March 2023 to May 2024) were collected. Overall adherence to the SBC was low at 7.6%. The median compliance with good practices was similar before and after the intervention at 57%. There was a slight variation in the median of maternal good practices (33.3%), while neonatal good practices remained stable (72.1%). The mean percentage of adverse events in general, maternal, and neonatal cases showed a decrease from baseline, with maternal adverse events showing a tendency to decrease. Discussions: The introduction of new practices faced resistance from the team, possibly due to the local context of work overload and the safety culture's maturity level. The designed strategy requires new improvement cycles with actions to raise awareness and prepare for using the instrument. Investing in the training of health service leaders is necessary to motivate changes and ensure sustainability. Conclusions: Some obstacles made it difficult to adhere to the list, such as a weakened safety culture, and thus no improvement in good practices and a decrease in adverse events were observed, despite maternal adverse events. It is also necessary to strengthen the patient safety center and develop leadership.