Professional Documents
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Evaluating the quality of care for severe pregnancy complications The WHO near-miss approach for maternal health
ment of new ones for the purpose of the nearmiss approach, can stimulate action for change
and contribute to the long-term sustainability of
actions to improve quality of care. It is nevertheless fundamental to have one person in charge of
coordination of all activities related to the implementation of the approach within each participating facility. It is recommended that the person
appointed to lead the implementation of the
approach should have good clinical knowledge of
severe maternal complications and the capacity
to lead and motivate the facility staff to change
practices.
2.1.8 Ethical considerations
The basic near-miss approach requires no direct
interaction with patients. All needed data are
extracted from health-facility records without
any patient identification. Since no information is obtained direct from patients, no patient
interviews are required. Staff at a participating
health-care facility may be required to clarify
doubts about individual cases during data collection or when the required information is missing.
Confidential information about the identity of
individual participants (i.e. individual participant
identification number, name, facility registry code
and hospital arrival date) is kept undisclosed by
the data collector in a separate logbook, which is
used only to complete forms in case of doubts or
missing data. Given the above precautions and
that individual participants are not approached
direct for data collection, obtaining informed
consent from individual patients is regarded
as unnecessary. However, appropriate institutional authorization should be obtained. The
privacy officer (or the professional overseeing
activities related to access to individual patients
health information) should be also involved, if
such a position exists at the health-care facility.
Research projects using similar approaches have
been approved by WHO and other ethical review
committees (21, 22). The full near-miss approach,
as conceptualized in Figure 1, and including
interviews and other interventions may have other
ethical requirements to be addressed by the
appropriate ethical review committee.