QUALITY MANAGEMENT IN PRE- CHRISTMAS ASSISTANCE : INFECTIONS TO ATTENTION URINARY GESTATIONAL
prenatal care, quality management, child mortality
Introduction: Urinary tract infection in pregnancy is an important condition that can harm the health of both, the mother and child and increase maternal and neonatal mortality. Adverse pregnancy outcomes are related to failures in prevention and response capacity before prenatal complications, childbirth and postpartum. Currently, the lack of studies on strategies that promote improved quality of prenatal care and strengthen public management strategies to optimize work processes, improve access of women to services that perform prenatal and especially qualify the assistance during pregnancy. Objective: To evaluate the effects of a quality improvement cycle in the prevention and management of UTI during prenatal. Methodology: This is a quantitative study with partly completed experimental design type before and after, no control group. An external cycle of quality improvement, with evaluation of five criteria of quality and two sentinel indicators were applied. Two evaluations were carried out, considering the time of three months between them, and two monitoring type Lot Quality Acceptance Sampling - LQAS. Between the first and the second evaluation, a participatory intervention, planned and guided by the first evaluation was applied. Samples were random, consisting of 120 cards pregnant women between 36 and 42 for the assessment of the criteria 1, 2, 3 and 4, besides the perinatal mortality data were collected from the Municipal Management Report. In order to identify the level of quality, it was used the point estimate and confidence interval (95%) of compliance with the criteria.Aiming to prove the effectiveness of the intervention, the Absolute and Relative improvements were calculated between the first and second evaluation, as well as its statistical significance with one-sided z test. Results: Multivariate analysis of quality improvement, it was observed that most of the criteria of statistical significance (p> 0.001), except criterion 1 which showed a p lower than expected. The criteria 1, 2 and 4 achieved a percentage above 65% compliance in both the samples. With respect to criterion 5, it can be inferred that 10.8% of the analyzed sample contained record examination results EQU and / or altered urine culture, and of these 53% had adequate treatment record. Perinatal mortality rate had a significant decline of 4.7% between 2014 and 2015, and early neonatal mortality rate decreased by 3.23% between 2013 and 2015. Conclusion: The methodology used to improve the quality of the external cycle collaborated in the remodeling of the care processes of prenatal and especially in the integration between care teams and managers of different levels of complexity worked, strengthening co-management and co-participation of workers involved directly in care for users in the municipal health management processes. It has also enabled reflections on the existing flowcharts, providing the redesign of the same as reflected in improving access of pregnant women to health services and quality care.