Patient safety

WHO 7 Day Mother Baby mCheck Tool

The concept

WHO Patient Safety has demonstrated improved outcomes through the use of clinical checklists to improve the safety of patients. All the checklists to date have been aimed at use by healthcare professionals. However, in keeping with our belief that safer care starts with the patient, we feel that the proven safety benefits achieved by clinical checklists could be replicated with a checklist style tool for patient use.

As part of the commitment towards the achievement of the UN Millennium Development goals, WHO Patient Safety has chosen to target the first patient-held checklist style tool at mothers and their babies. This tool is being developed using an innovative patient-centered approach combining expert consensus with global patient response and will focus on a mother checking for key danger signs in herself and her baby in the first seven days after the baby is born.

Purpose of the tool

The tool will aim to increase safety during the high-risk postnatal period for mothers and babies by:

  • ensure safe discharge from skilled care,
  • facilitate a mother’s decision to access skilled care in a timely and appropriate manner, and
  • empower mothers with knowledge.

The tool is not designed to be comprehensive. By focusing on key danger signs, it targets only the most common and most burdensome causes of maternal and neonatal morbidity and mortality in the immediate and early postnatal period, as defined by WHO. It is intended to be simple and easy to use by all mothers globally in settings of varying economic profile and literacy. We have chosen the first seven days as this is a known high risk period when the majority of maternal and newborn deaths occur. Most of these occur at home (regardless of location of delivery and presence of skilled attendant) and are avoidable with improved care during the immediate and early postnatal period.

How does the tool work?

The tool uses well recognized, evidence-based danger signs for a mother and her baby in the first seven days after birth to trigger questions that a mother can ask herself during this period. Upon identifying any of these danger signs in either herself or her baby, the tool can help a mother make an informed decision about the severity and urgency of the problem and when to access skilled care. The tool is designed to promote appropriate and timely health-seeking behaviour and ultimately reduce maternal and neonatal morbidity and mortality.

This decision making process will be further enhanced by the use of mHealth (mobile phone) technology. Mothers will be able to use the tool as a trigger to call an interactive automated system in their local language, that will further guide their decision-making process regarding seeking skilled care.

Tool development

This tool is being developed using an innovative patient-centred approach combining expert consensus with global patient response. The ‘by patients for patients’ approach is being led by a number of our PFPS Champions across the world. By harnessing their local networks of stakeholders including mothers, fathers, grandmothers, midwives, obstetricians and community healthcare workers, it is hoped that the tool will truly respond to global patient need.

Phase I of development involved a basic needs assessment whereby 9 Patient Champions (from 9 countries) used a combination of surveys and questionnaires to ascertain that there was a need expressed in their networks for the development of such a tool.

Phase II involved nine Patient Champions (from 9 countries) running focus groups with their networks to help guide the development of a draft tool that incorporates cultural sensitivities and needs.

Phase III - PFPS Champions in 11 countries joined together with a health provider partner to run focus groups with key stakeholders to further refine the tool and assess the feasibility of the mHealth component.

Official piloting of the tool is now taking place in Karnataka, India , due for completion October 2013.