The quality of recordkeeping during intrapartum care in Limpopo Province : a mixed method analysis

Abstract

Quality medical and nursing care requires detailed recordkeeping, which includes complete and accurate recording. Data sourced from the Ministry of Health indicated that Limpopo Province is the second-highest province in the Republic of South Africa with 215 medicolegal claims by the end of 2021. This study developed strategies to improve the quality of recordkeeping during intrapartum care and to reduce legal claims through improved recordkeeping standards. The purpose of the study The study purpose was to evaluate the completeness of the maternity case records and to develop strategies to improve recordkeeping during intrapartum care. Methodological processes The researcher applied a sequential explanatory mixed methods design. A systematic sampling was used to select every 10th entry in the maternity delivery register from the 01st of January 2021 till 31st of December 2021. This sample size is representative of 10% of maternity case records of all the women who delivered in the given period. Non- participant unstructured observations and a checklist were used to collect quantitative data. This study used convenience sampling to select midwives for focus group discussions (n=29) and purposeful sampling to select the medical practitioners (n=14) for in-depth interviews to determine their perceptions and experiences regarding recordkeeping during intrapartum care. The research further applied a Delphi approach that involved twelve (n=12) experts to validate the developed strategies for recordkeeping. Qualitative data was collected by use of an interview guide for both midwives and medical practitioners. iii Data analysis process The IBM Statistical Package for Social Sciences (SPSS) version 23 was utilised to analyse quantitative data. Thematic analysis was applied to analyse qualitative data at the interpretive level of the study, the integration of the quantitative and qualitative data was accomplished. Research results The non-participant unstructured observations of the study established that barriers to quality recordkeeping are existing. The research results illustrate the gap on completeness and accuracy of the vital signs variables. A total of 58.8% of the variables for medial upper arm circumference (MUAC), 57.4% for body mass index (BMI), 57.2% for height, 55.1% for oxygen saturation, 43% for respiration, 50.2% for urinalysis, 67.7% for blood pressure and 51.2% for pulse rate variables in the maternity case records were not fully completed. The study further indicated that 91% of the guidelines were available. The qualitative findings supported the quantitative results. Study recommendations Based on the findings, the researcher developed strategies to improve recordkeeping during intrapartum care in Limpopo Province. The strategies were validated through a Delphi technique with the panel of experts. Finally, recommendations were made to clinical practice, future research and policy making.