1.Program evaluation and early outcomes of a severe preeclampsia and eclampsia maternal safety bundle in a single institution in the Philippines
Zarinah Garcia Gonzaga ; Maria Rosario Castillo‑Cheng ; Joseph Carl Macalintal ; Lizzette Caro-Alquiros ; Stephanie Causin ; Grace Lynn Santos Estanislao
Philippine Journal of Obstetrics and Gynecology 2024;48(2):83-89
Background:
To reduce maternal morbidity and mortality associated with hypertension, standards for
maternal safety and efforts to implement a structured team approach have been undertaken. Following the formulation of a policy document, a maternal safety bundle was developed. The implementation of bundle components including eclampsia kits, clinical pathways, and educational module occurred in phases due to pandemic restrictions. An eclampsia kit and clinical pathways were implemented in 2020. An online lecture was launched in 2021 followed by in-person eclampsia simulation workshop beginning 2022.
Objectives:
This paper aims to report the early outcomes of a severe preeclampsia and eclampsia maternal safety bundle implementation in a private hospital between 2020 to 2023.
Materials and Methods:
Demographic information, posttest knowledge assessment and preand post- eclampsia workshop confidence scores were recorded. Structure, process, and outcome
measures were determined. Descriptive statistics were used for participant demographics and score
percentages. Paired t-Test with a significance level of P<0.05 was used to compare the pre- and
post-simulation confidence scores. Summary data for outcome and process metrics were manually
calculated. Summary categorical data was used for structure metrics.
Results:
Two hundred eighty-eight (288) participants completed the online didactic lecture. Average
posttest knowledge assessment score was 88.1%, 88.88%, and 82.6% from 2020 to 2023. Ninety-nine
participants completed the eclampsia simulation workshops. Mean post-simulation confidence scores
were greater than mean pre-simulation confidence scores (42.3 vs. 39, p=0.0259 in 2022 and 41.975 vs
36.65, P=0.0035 in 2023). There is 100% compliance with timely management of severe hypertension
and eclampsia prevention and a decreasing trend in hypertension related severe maternal morbidity rates.
Conclusion
A severe preeclampsia and eclampsia maternal safety bundle is a feasible quality
improvement initiative that promotes peer learning, strengthens clinical competencies, and improves
access to emergency resuscitation supplies. The results of this program evaluation may serve as a
framework for implementing quality improvement initiatives on maternal safety.