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WONDER: Women’s Obstetrical Neonatal Death Evaluation & Reduction

Background:
  • About 99% of all maternal deaths occur in developing countries and among poorer communities.
  • For every maternal death, about 100 women will suffer severe maternal morbidity.
  • These women who have gone through severe morbidity may have a similar diagnosis and similar rates of preventable factors as the mothers who died.

Women who ultimately die during childbirth rarely go directly from being in a healthy state to death but rather go through a transition period. During this important transition, significant changes happen in the patient’s vital signs, which if not recognized, may result in the patient going into seriously compromised state and it may become too late to prevent death.

About WONDER Electronic Health Record System:
  • A smart electronic health record system (WONDER – Women’s Obstetrics Neonatal Death, Evaluation, and Reduction) developed to prevent maternal deaths and near misses
  • Importance is given to the changing vital signs with a particular attention to the time in labor and immediate postpartum period when 70% of maternal deaths occur.
  1. The system is designed to alert the providers when there is a change in vital signs of a patient giving enough time to the doctors to initiate treatment before it becomes too late.
  2. It also helps to identify a sick patient in a crowded labor room where one nurse is taking care of a large number of laboring patients.
  3. In addition to the alerts, the system also gives the diagnostic possibilities and up to date treatment options.
  • WONDER system also works in conjunction with electronic Birthing center (e-BC) similar to e-ICU. GH functions as e-BC and the PHC (Primary Health Center) are connected to E-BC with two way communication.
  1. This allows a low level provider to initiate emergency treatments while they wait for the doctors.
  2. Helps to address the lack of skilled obstetric providers in small and remote PHCs
Special Features of WONDER Program: 
  1. An Electronic Health Record system dedicated to preventing maternal deaths and near misses
  2. Built-in color-coded vital signs chart called,” Maternal Early Obstetric Warning Score System ( MEOWS)” which is approved and highly recommended by Royal college and American College of Obstetrics and Gynecology.
  3. Gives an audible alarm when the vital signs are abnormal and the name of the patient and the abnormal values appear on the dashboard in red.
  4. Gives a possible diagnosis and appropriate treatment guidelines.
  5. Incorporated the evidence based management protocols for Postpartum hemorrhage, pre-eclampsia/eclampsia, maternal sepsis, anemia, gestational diabetes and for most of the possible causes of maternal mortality or maternal harm.
  6. Ability to assess system wide treatment responses and change course if adequate response is not reached.
  7. Easy to generate any type of reports required by the Government or for any purpose thus making it easy to institute new policies and standards
  8. Unique ID for each individual creates a sense of responsibility. All entries are time sensitive and no one can alter the records. This allows the review process the ability to reconstruct the events when there is an adverse event and identify areas of weakness or knowledge gap paving the way for corrective measures.
  9. Entire system is safe and secure (HIPPA Compliant)

This had been implemented successfully in Erode Government Hospital, Tamil Nadu India. Phase II involves 3 GH and 6 PHCs, which is ongoing. The preliminary results show that the positive trends and significantly helping the providers by identifying the sick patients early for them to respond right away. We are getting extremely positive feed backs from the doctors, nurses and supervisors. Will be coming with complete analysis soon.