Melhoria da adesão à lista de verificação para o parto seguro da Organização Mundial da Saúde em uma maternidade brasileira

Abstract

Introduction: In Brazil, the Maternal Mortality Ratio remains high, and even with the decrease in infant mortality, avoidable neonatal mortality continues to be responsible for most deaths. The World Health Organization (WHO) proposes a way to improve care and increase adherence to safe practices in childbirth, it is the use of the Checklist for Safe Childbirth. Even with the evidence that its use can increase the performance of good practices in childbirth, the continuous use of LVPS is still a challenge. Objective: Increase adherence to the WHO Safe Birth Checklist (LVPS) in a high-risk maternity hospital in northeastern Brazil, specifically intended: to identify possible barriers to the use of the List; implement interventions to improve adherence to the LVPS and monitor adherence before and after interventions. Method: This is a quasi-experimental study (without control group), of time series, with measurement of six months before and six months after the interventions, totaling 692 medical records (332 before and 360 postintervention); the study site is a high-risk maternity hospital in Natal, Rio Grande do Norte. The project follows the steps of an improvement cycle: root cause analysis, definition of improvement measurement criteria, baseline analysis, participatory planning of interventions, implementation of interventions, and monitoring. The analysis of the causes used the Ishikawa Diagram and the Consolidated Framework for Implementation Research (CFIR). The criteria measured were: percentage of Lists fully completed; percentage of items completed and percentage of items completed by time of pause (admission, immediately before delivery, shortly after birth, and before discharge). The analysis of improvement was carried out through run charts, considering the significance of 5% Results: The barriers to adherence identified were related to three domains of the CFIR: inner setting, innovation and implementation process. After the interventions, the median percentage of items filled out increased from 38.8% to 58.7%, a significant improvement. There was also a significant improvement at the time of admission and shortly after birth. The moment with the lowest completion was immediately before delivery (median of 27.6%). The moment of discharge showed an increase in adherence, but was not significant. Conclusions: The identification of barriers allowed us to direct the interventions of the improvement cycle. The context was favorable to the implementation of process changes, especially due to the involvement of the Quality Management sector. There was an improvement in adherence to the LVPS, and it is important to invest in strategies such as permanent education, raising awareness of leaders and strengthening the safety culture for its sustainability.