Implementing a labor monitoring guideline and midwives responsibilities to increase the completion rate of partograph in Muhima Hospital, Rwanda

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On the Horizon


Purpose: Complete health documentation during childbirth can reduce complications and improve maternal and foetal outcomes. One such document is the partograph which allows health workers to record and follow the labour progress. However, the completion rates of partograph remain low in some hospitals. This study describes the implementation of a quality improvement project to increase the completion rate of partograph in a district hospital in Rwanda. Design/methodology/approach: The project team tackled the root cause of partograph incompletion by implementing a labour monitoring guideline, assigning patients and duties to midwives and by providing support and supervision. Findings: The intervention successfully increased overall partograph completion rates from 11 to 61 per cent, p < 0.001. This study also showed that completeness of the partograph was statistically associated with a decrease in foetal deaths and higher Apgar score with p < 0.001 for both. Practical implications: This study describes the establishment of a quality improvement project following the strategic problem solving approach to increase the completion rate of partograph documentation. The intervention was simple, data-driven and cost-neutral. The team achieved its objectives by integrating staff input, obtaining commitment from the multidisciplinary team and applying leadership skills. Originality/value: The results are useful for hospitals in limited resources settings wishing to improve overall partograph completion and improve foetal and maternal outcomes during labour, in an efficient and cost-neutral way.

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