62 AFRICAN JOURNAL OF MIDWIFERY AND WOMEN’S HEALTH, APRIL–JUNE 2017, VOL 11, NO 2 LAMRN PROFESSIONAL © 2017 MA Healthcare Ltd Why clinical audit is important in midwifery: experiences from Kenya By Edith Wathira Gicheha, Yana Richens, Rosemary Mideva Kivai and Tina Lavender Abstract Background: Clinical are an assessment of working practice against an agreed standard, with the intention of identifying areas for improvement and recommending interventions to address them (Mancey-Jones and Brugha, 1997). However, audits are not widely used in low or middle income countries. LAMRN set out to strengthen the capacity of midwives in Kenya to carry out clinical audits Aim: To describe the development of an audit project in Kenyatta National Hospital and Pumwani Maternity Hospital. Methods: Midwives were asked to identify auditable areas from clinical practice, which were ranked in order of priority. The problem with the highest score following ranking was chosen for audit and discussed with the management and clinical teams in each hospital. An audit protocol was then designed and an audit completed. This article highlights how the audit was undertaken; results are due to follow. Findings: Midwives in both hospitals agreed to audit postpartum haemorrhage and developed an audit proposal. This outlined the audit objectives, critical standards for the management of postpartum haemorrhage, data collection methods, timelines, roles of each team member and expected outcomes. Conclusions: Using a systematic approach, midwives in Kenya were able to identify an auditable problem, set clear objectives and standards to conduct the audit and develop methods to carry out the audit successfully. Keywords: Audit, Postpartum haemorrhage, Midwives C linical audit has been described as a quality improvement process which seeks to improve patient care and outcomes through systematic review of care against explicit criteria (Morrell and Harvey, 1999). Clinical audit was first used by Florence Nightingale during the Crimean War 1854–1855, at Scutari Hospital, Turkey. It was here that Nightingale used her mathematical background to collect data on the high mortality rates of wounded soldiers. Nightingale found that soldiers were more likely to die from preventable diseases such as typhus, typhoid, cholera and dysentery than the injuries they sustained during the battle (Meyer and Bishop 2007; Fawkes 2012). As a result, the hospital received a visit from the sanitary commission, and laundry facilities were implemented in battlefield hospitals, leading to a reduction in death rates from 40% to 2%. This was the beginning of clinical audit. However, despite its clear advantages, it was over a century later, in 1989, that the UK’s Department of Health recommended in a white paper, Working for Patients (Department of Health, 1989) that audit should become part of routine clinical practice, saying that: ‘Clinical audit is the systematic and critical analysis of the quality of clinical care, including procedures used for diagnosis, treatment and care, the associated use of resources and the resulting outcome and quality of life for the patient.’ (Department of Health, 1989) Today, audits are widely used to improve the number of best practices that are used in the clinical care. Best practices are treatment methods that are based on the best available evidence at the time. Audits are an assessment of working practice against an agreed standard, with the intention of identifying areas for improvement and recommending interventions to address them (Mancey-Jones and Brugha, 1997). If a clinical or service problem can be brought into focus by audit then it is more likely that the clinicians can find solutions and monitor change (Dyke, 1993). Audit depends on the presence of a standard, which might be in the form of a standard operating procedure, protocol or guideline. These should govern practice or procedures in any hospital and offer a guide for clinicians on best practice. They could relate to simple procedures, such as the administration of an intravenous drug, to more complex guidelines, such as newborn resuscitation. It is these standards that contain the criteria for audit. Without these, it is not possible to Edith Wathira Gicheha, neonatal nursing lecturer, Kenyatta National Hospital; Yana Richens, Global Advisor, Royal College of Midwives, and consultant midwife, University College London Hospital NHS Trust; Rosemary Mideva Kivai , Kenya registered community health nurse, Pumwani Maternity Hospital; and Tina Lavender, professor of Midwifery, and director, Centre for Global Women’s Health, University of Manchester Correspondence: yanarichens@aol.com © MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 130.088.088.244 on February 13, 2018. Use for licensed purposes only. No other uses without permission. All rights reserved.