Background
Methods
Study design and setting
Participants
Topic guide
Data collection
Analysis
Ethics
Results
Participants’ characteristics
Emerging themes
Sub-theme | Quote | |
---|---|---|
Awareness of infectious morbidity | Q1 | “A pregnant woman is prone to infection” FGD P9 Midwife |
Q2 | “Often we see infection after delivery” KII 12 Doctor | |
Awareness of the severity of the effect of infections on the health of the mother | Q3 | “In the periphery (community) they tend to detect infections really late, so by the time they get here …. the patient is very sick” FGD P5 Doctor |
Q4 | “So, by the time you realize they have infection the infection is already severe, and their life is at risk” KII 4 Nurse Midwife | |
Q5 | “Patients come back to hospital after they have recently been discharged home after delivery, some very sick, some even dead, and we believe most of them were discharged with an infection, but this was not recognised” KII 10 Doctor | |
Current practice to detect infectious morbidity | Q6 | “We check if there are any vaginal sores, we also check for syphilis and treat any infection in the mother and the child plus the father” FGD P4 Nurse Midwife |
Q7 | “When we triage, we check vital signs, in order to decide if the patient is an emergency patient, or a priority, or one that requires to be in the queue” KII10 Doctor | |
Q8 | “So normally in our department we do our own triage system, yes, that is to check which patients are in need of urgent care, yes we do that” KII 4 Nurse Midwife | |
Q9 | “We use the CHEWA early warning score in the high dependency unit here” FGD 2 Nurse | |
Q10 | “I have heard of the SOFA score for sepsis” KII 6 Doctor | |
The benefits of using an early warning score | Q11 | “The early warning tool for sure is very important because the more we are able to detect infection early the more we help save the lives of the mums and even the babies” FGD P8 Midwife |
Q12 | “I think that screening tools are important, as they help to detect the early signs of infection in a patient.” KII 2 Doctor | |
Q13 | “An early warning score will guide us to the management of the patient” FGD P8 Nurse Midwife | |
Q14 | “Earlier detection [of infection] equals to earlier treatment equals to earlier discharge and this prevents ‘congestions on the postnatal ward” KII 3 Doctor |
Sub-theme | Quote | |
---|---|---|
Lack of resources | Q14 | “Sometimes people may neglect to check the vital signs as there aren’t the resources available” KII 7 Doctor |
Q15 | “On labour ward our main challenge is lack of resources, we may find that for a whole day we don’t have a thermometer” FGD P7 Midwife | |
Q16 | “There may not be any thermometers there, sometimes you find there aren’t the tools to do what you want” KII 10 Doctor | |
Q17 | “Resources are a problem” FGD 8 Nurse Midwife | |
Q18 | “Sometimes there are no batteries for the electronic blood pressure machines” FGD 1 Nurse Midwife | |
Q19 | “There is lack of labs tests and the white cell count takes several hours to be done” FGD 2 Nurse | |
Q20 | “We need a paper supply for the observations charts” FGD 1 Nurse | |
Lack of trained staff and time | Q21 | “The large number of patients with a small number of staff means that we are always short of time, and it may be difficult to assess each woman in full” KII7 Doctor |
Q22 | “So maybe there are two nurses so really to monitor patients like they are supposed to its not really a simple task sometimes patients are missed” KII4 Nurse Midwife | |
Q23 | “Short staff time because you find there are many patients” FGD 8 Nurse Midwife | |
Lack of understanding of how to interpret the score | Q24 | “You can have the tools or scores but if you don’t have knowledge on how to interpret these then there is nothing you have done” FGD 2 Midwife |
Q25 | “Focusing on the score only can, in rare cases, result in overseeing other issues” KII 8 Doctor | |
Lack of freely available medication | Q26 | “Infection may be detected but patients may not have funds to buy treatment” FGD 1 Nurse |
Sub-theme | Quote | |
---|---|---|
Usefulness of colour codes | Q27 | “If it could be printed in colour, using a traffic light system, then one should be able to interpret findings very quickly” FGD P9 Nurse Midwife |
Education of healthcare providers | Q28 | “Orientation to the screening tool is needed so everyone understands it well “KII6 Nurse Midwife |
Q29 | “So sometimes with the staff, you forget there are new people who can’t use it until they are trained” KII8 Doctor | |
Q30 | “I think with appropriate training we can use an early warning tool or score, it is such a simple tool to use” KII1 Doctor | |
Recognition of the need to screen and using an early warning score | Q31 | “If each and every one would know the importance of screening that would help - some people may not know its importance now” KII7 Doctor |
Q32 | “Yes, I think we (as a team) should be able to use an early warning score or tool. The fact that the midwives in the labour ward high dependency unit use it already means that everyone can actually use it” KII8 Doctor | |
Q33 | “With appropriate training it [an early warning score] could be used more widely in our department. it could be implemented everywhere in hospital” KII9 Doctor | |
Q34 | “It’s now about training everyone, orienting everyone, on how to effectively use it … because that tool is as good as the information you put on it” KII1, Doctor | |
Local clinical leadership and use of audit | Q35 | “We need dedicated staff to pioneer it [early warning score] as happened in the high dependency unit, the introduction of score in other areas [of the hospital] have failed previously” KII 1 Doctor |
Q36 | “If doctors haven’t welcomed the idea, they will stick to the process they learnt in college” FGD 7 Nurse | |
Q37 | “[We need to] use audits before and after to see what the issues are in implementation [of the early warning scores]” KII Doctor |