Normative evaluation of emergency obstetric care in the prevention of COVID-19

Normative and observational evaluation study in the Care sectors (Risk Classification and Obstetric Emergency) of a public maternity hospital in Rio de Janeiro. Data collection was carried out from June to August 2020 for 480 hours of non-participant direct observation, with records systematized in a checklist containing variables related to the availability and compliance of structural resources, and the compliance of the care flow. Data were organized into spreadsheets (Microsoft Excel® 2010) and analyzed using descriptive statistics.

Results

The framework assessment scored 80.3% availability, resulting in a high availability rating, and 91.1% compliance, achieving adequate compliance. The care flow showed 72.7% of total compliance; 9.1% of partial compliance and 18.2% of non-compliance, configuring high compliance.

Conclusion

Normative evaluation indicated high availability and compliance in structure and care flow in the studied scenarios.

Health evaluation; Process assessment, health care; Pregnancy women; User embracement; Pregnancy complications, infectious; COViD-19; Disease prevention

Framework availability and compliance criteria (per scenario)	Availability	Compliance
	n(%)	n(%)
Care at the entrance
Space at the entrance for initial care and identification of suspected cases	2(100)	2(100)
Exclusive entrance for suspected cases	0	0
Teams for exclusive care at the entrance door	0	0
Vials with alcoholic preparation	2(100)	2(100)
Resources for simple hand hygiene.	0	1(50)
Bin for disposing of tissues	2(100)	1(50)
PPE for customers	2(100)	1(50)
PPE for professionals	2(100)	1(50)
Compliance with the Brazilian Technical Standard for Accessibility (9050)	2(100)	2(100)
Mean	66.6	55.5
Waiting space
Exclusive ports for suspected cases	0	0
Exclusive space to accommodate suspected or confirmed cases	2(100)	2(100)
Teams for exclusive care of suspected or confirmed cases	0	0
Vials with alcoholic preparation	2(100)	2(100)
Hand hygiene resources.	2(100)	2(100)
Bin for disposing of tissues	2(100)	1(50)
PPE for customers	2(100)	1(50)
PPE for professionals.	2(100)	1(50)
Signaling on the respiratory label	2(100)	1(50)
Ventilation	2(100)	1(50)
Drinking fountains and public telephones	2(100)	2(100)
Mean	2(100)	2(100)
Attendance room
Exclusive entrance for suspected cases	0	0
Teams for exclusive care in suspected or confirmed cases	0	0
Vials with alcoholic preparation	2(100)	2(100)
Hand hygiene resources	2(100)	1(50)
Bin for disposing of tissues	2(100)	1(50) 1(50)
PPE for customers	2(100)	1(50) 1(50)
PPE for professionals	2(100)	1(50)
Signaling on the respiratory label	2(100)	1(50)
Number of chairs	2(100)	2(100)
Lighting and acoustics	2(100)	2(100)
Ventilation	2(100)	1(50)
Resources for checking vital signs	2(100)	2(100)
Physical examination resources	2(100)	2(100)
Resources for oxygen therapy	2(100)	2(100)
Resources for upper airway aspiration	2(100)	2(100)
Resources for Fetal Assessment	2(100)	2(100)
Resources for resuscitation	2(100)	2(100)
Resources for hygiene and disinfection of supplies and change of bed linen at each service	2(100)	2(100)
Space for dressing and undressing	0	0
Mean	84.2	68.4
Quick response room
Teams for exclusive care in suspected or confirmed cases	0	0
Vials with alcoholic preparation	2(100)	2(100)
Hand hygiene resources	2(100)	2(100)
Bin for disposing of tissues	2(100)	1(50)
PPE for customers	2(100)	1(50)
PPE for professionals.	2(100)	1(50)
Signaling on the respiratory label	2(100)	1(50)
Bed layout	2(100)	2(100)
Lighting and acoustics	2(100)	2(100)
Ventilation	2(100)	2(100)
Resources for oxygen therapy	2(100)	2(100)
Resources for upper airway aspiration	2(100)	2(100)
Resources for multiparametric monitoring	2(100)	2(100)
Resources for resuscitation	2(100)	2(100)
Infusion pumps	2(100)	2(100)
Mechanical fan	2(100)	2(100)
Resources for hygiene and disinfection of supplies and change of bed linen at each service	2(100)	2(100)
Space for dressing and undressing	0	0
Mean	88.8	80.5
Mean of the total percentage	80.3	70.5

Structural flow compliance criteria per scenario	n(%)
Care at the entrance
Reception, evaluation and characterization of women as a suspected case or not	2(100)
Risk rating	2(100)
Guidance for women on hand hygiene and respiratory etiquette	2(100)
Provision of PPE for all women	1(50)
Availability of PPE for professionals	1(50)
Assistance by exclusive teams to suspected or confirmed cases of COVID-19.	0
Average percentage of compliance	66,6
Waiting space
Keep suspected or confirmed cases in an exclusive area	2(100)
maintenance of distance	2(100)
Assistance by exclusive teams to suspected or confirmed cases of COVID-19.	0
Average percentage of compliance	66,6
Attendance room
Priority care for suspected or confirmed cases.	2(100)
Assessment of suspected or confirmed cases, including fetal well-being	2(100)
Referral of women with SARS signs to the “Rapid Response Room”	2(100)
Hand hygiene at each visit	2(100)
Dressing and undressing in an exclusive and signposted area.	0
Assistance by exclusive teams to suspected or confirmed cases of COVID-19	0
Average percentage of compliance	66,6
Quick response room
Installation of multiparametric monitoring	2(100)
Assessment of maternal vital signs	2(100)
Fetal assessment	2(100)
Care related to oxygen therapy	2(100)
Care related to upper airway aspiration	2(100)
Hand hygiene at each visit	2(100)
Dressing and undressing in signposted area	0
Cleaning and disinfection of resources and change of bed linen at each visit	2(100)
Mean percentage of compliance	87,5
Mean total percentage of compliance	71,8

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Sandra Cristina de Souza Borges Silva E-mail: scrisborges@hotmail.com