Banca de DEFESA: SAMARA PEREIRA DANTAS LEMOS

IMPROVEMENT OF THE QUALITY OF OBSTETRIC AND NEONATAL CARE IN HABITUAL RISK MATERNITY 

IN RIO GRANDE DO NORTE STATE, BRAZIL

Quality of Health Care. Indicators of Health Services. Quality Improvement. Humanized childbirth.

INTRODUCTION: the maternal and neonatal morbidity and mortality can be prevented with quality and safety care. These are preventive measures that guarantee the improvement of the quality of care during labor and birth.

OBJECTIVE: to increase adherence to practices in the State of Rio Grande do Norte.

METHOD: This is a quasi-experimental study with a cycle of improvement with data analysis before and after the intervention. A retrospective review of medical records of 108 deliveries (baseline) and 102 deliveries (post-intervention) was performed, selecting 420 deliveries (mothers and newborns), selected by systematic total randomization. The intervention, carried out in conjunction with a service team and other changes, consists of training on good practices, reactivation of training on good practices, reactivation of collective actions. As variables of interest to the study, indicators include simple and composite events of good practices and adverse events. A descriptive analysis was performed with absolute and relative frequencies and a 95% confidence interval (95%CI) and for the analysis of the improvement of post-intervention good practices, the Student's T test was applied, considering a value of p<0.05.

RESULTS: It was observed that 89.52% of the mothers were between 14 and 34 years of age, 96.19% of the total deliveries were carried out in the term or post-term period (with 37 or more gestations), 89% of the pregnant women had up to 03 days of hospitalization and 60.9% of the deliveries were normal. The main causes of the low performance of good practices are related to the work process and continuing education. After the intervention, there was an increase in practices: filling in the partogram (p=031), time for the companion (p=0.002), replacement of the 1st skin between mother and baby (p<0.001), administration of vitamin k (p <0.001) and newborn identification with a bracelet (p<0.001). The proportion of deliveries with at least one adverse event in relation to the total deliveries considering the two periods was 9.5%.

CONCLUSIONS: it is possible to induce an increase in the implementation of good practices in childbirth care in health services through a multifaceted intervention. It is necessary to invest in strategies for the sustainability of this improvement.