The MOTHER Initiative USER`S MANUAL
Contents
1. MD PhD okhuizen MP an Beek peleen V and pegine Unkels 1 SAPIENS SA SING wy i L ie g Zz ALARM International Ba A Program to Reduce Maternal and Neonatal yv Eg al Mortality and Morbidity pase D a u International Fourth Edition G1iowm The Global Library of Women s Medicine www glowm com 7S is SAMSUNG PATIENT DETAILS Care Provider Name Number Patient Family Name Given Name Home Address Contact Phone Number Birth Year Date Registered First Day of Last Menstrual Period Due Date Gravidity Miscarriages Abortions Live Births Dead Births Previous Medical Hypertension Risk Complications Diabetes HIV Infection Sickle Cell Disease Previous Cesarean Section Review All Patients Information First Ante natal Visit 14 18 Weeks Second Ante natal Visit 20 24 Weeks Third Ante natal Visit 28 32 Weeks Fourth Ante natal Visit 36 38 Weeks Birth Record Individual Patient Record Contact2. features a digital pregnancy birth calculator which enables the midwife to calculate very rapidly and accurately the estimated birth date and other key dates of any pregnant woman Enhancing contact Since 7he MOTHER nitiative is based around a smartphone albeit it one with a specially large screen the program may also be used for rapid contact with other health professionals The program allows for instant phone and texting to a range of support contacts and it also allows for emailing more detailed messages when appropriate Finally there is also a Help facility designed to provide technical support to any individual midwife who encounters operational problems with the use of the device or its program EXPLAINING THE PROGRAM continued How it works 2 mee MET SAMSUNG The MOTHER nitiative program is based around the smartphone a PATIENT DETAILS with the largest display screen that is currently available the ees Si Samsung Note Its screen measures 5 5 inches and it does therefore T TN provide quite a satisfactory platform for viewing medical records Pall entering new data and clearly viewing video based resources as Well fE contact hone number Birth Year as texts Of course it also functions as any normal phone oO S eb o ag oO g Before being made available to midwives each smartphone is pre loaded with the whole program it therefore comes entirely ready to use Actually updates
3. women die in childbirth or suffer unnecessarily from complications arising as a result of it In many countries with higher than average mortality and morbidity rates there are a range of different reasons for this but two of the most important causes are that e Pregnant women fail to seek proper clinical care do not attend for antenatal check ups and often undergo childbirth at home with unskilled assistance e The people who care for them in childbirth often lack the necessary knowledge to manage unexpected obstetric emergencies successfully The MOTHER Initiative has been designed specifically to try and address both these problems And it does so by combining the best current clinical practice with the latest mobile phone and cloud computing technologies In effect it provides a practical aid to midwives that helos them overcome some of the challenges that many of them are used to encountering in their daily practice In addition and as a natural consequence of the way it has been designed it also provides health administrators with immediate access to a wide range of important health statistics and data that should be valuable to them in monitoring care and planning future improvements Part 1 EXPLAINING THE PROGRAM What it does Monitoring pregnant women he first module of the program is focused on monitoring pregnant women and on trying to ensure that they do actually attend pre natal check ups It does this by enabli
4. The MOTHER Initiative CU VARRY World Health C5 LOWM WY Organization The Global Library of Women s Medicine cao a Afia LES EE N The Mother nitiative is a completely new program that has been developed by he Global Library of Women s Medicine as a contribution to safer motherhood The program is being made available entirely free to locations where the appropriate local medical authorities feel that it can fulfill a useful role The origination of this program has been undertaken using the resources of The Global Library of Women s Medicine together with those of other contributing organizations and it has been developed in close association with the World Health Organization African Region who have provided their expert guidance experience and insights to assist in focusing it on critical clinical needs It is intended to continuously adapt and develop the program in the light of practical experience gained from its actual use and to broaden its scope when time and resources allow Director for Africa The World Health Organization President The Global Library of Women s Medicine Managing Director AMA Dataset Director The Global Library of Women s Meaicine Obstetrician Gynecologist and Consultant to WHO Ghana The Global Library of Women s Medicine is a not for profit Foundation dedicated to contributing to the enhancement of women s healthcare by making available expert peer reviewed cl
5. agement ST E P For more detailed information see text on the reverse side of this leaflet gt Controlled Cord Traction 1 ion CCT i Place the clamp near the woman s Perform contri i lold the cord close to the perineum using a ractions If a clamp is not tracti atten supporting the uteru ying Vaginal breech delivery 4 Skills videos A series of 5 short 3 4 minute expert videos with voice commentary demonstrating in an impressively clear style how to undertake basic birth related procedures An expert video presentation describing exactly how to manage breech delivery 12 5 Educational Films A selection of 17 very well designed educational films average running time about 10 minutes providing important insights into the management of many pregnancy and birth related issues 6 Community Education Animations A series of 14 short animations each about 3 minutes in duration with voice commentary providing simple visual guidance to women about pregnancy childbirth and newborn care for displaying to patients 7 Textbooks for immediate references 3 useful textbooks providing comprehensive coverage of the most important aspects of pregnancy and childbirth that can be easily searched and referred to for detailed and reliable on the spot guidance How to use the partograph A Textbook of Gynecology for Less Resource Locations Edited by
6. arance and which offer a practical way of ensuring that it is always readily available for use Assessing its clinical value Extensive trials will be undertaken to assess the practical benefits that can be derived fro the use of The MOTHER Initiative Each trial will be monitored by a local Trial Director and all midwives involved with the program will be invited to attend a special training course to familiarize themselves with both the program and with the smartphones on which it is run Further support will be provided to them throughout the course of the trials which are anticipated to run in the first instance for 12 18 months Outcomes from the trials and other indicators will be compared directly with those from matched control areas and the results published It is hoped that after any recommended modifications have been effected the whole program can be scaled up in appropriate areas on a much wider basis senefits of using the program It is anticipated that the following benefits should be derived from the use of The MOTHER nitiative e Improved contact between midwives and their patients e More detailed clinical records created for each patient due to the carefully structured record form that automatically presents to the midwife whenever a patient is examined Enhanced awareness by midwives of patients who are overdue for prenatal care Improved attendance generally for prenatal examinations Earlier identification of dange
7. arked Close and Submit Can two or more midwives view the same patient s records Yes If two or more midwives are working together and wish to share patients records they can both be issued with smartphones with the SAME log in code In this case both the phones records will be identical and when one midwife enters data on an individual patient that data will automatically appear on the other midwife s phone provided that mobile phone connectivity is available 10 What happens if a patient is overdue for an appointment select the Reporting Module by tapping on the first icon You will then see a screen with the caption Review All Patients If it is flashing on and off this means that a patient is overdue and one whose record you have not yet viewed Tap the icon Review all patients A list of patients will then appear and any that are overdue will be highlighted NB The patient will have already been sent an automatic reminder text if she has a mobile phone but you may also wish to remind her yourself by a direct phone call or by other methods Tap the relevant patient s name to view their current record To access the clinical support resources 1 2 Select the icon marked Information You will then see an extensive list of resources Select the resource that you would like to view NB Many of the videos have a sound commentary This is quite audible in a quie
8. dbirth statistics for their area covering a very wide range of clinical parameters These will provide important insights into current health morbidity and mortality issues that can contribute significantly to future planning and provision e Input data e Can review data of all their patients Access instant obstetric educational support e Receive alerts when patients are overdue e Contact other professionals e Receive updates from local health authority Ceg d Od The Cloud based The MOTHER management program t Regional Hospital e Can view details of each individual patient e Can analyze outcomes and review all performance e Can use data analysis to assist in future planning decisions EXPLAINING THE PROGRAM continued What Is needed To operate 7he MOTHER nitiative successfully very little infrastructure is required Principally just two elements must be present 1 The availability of a mobile phone network that provides connectivity to all the smartphones in the program for at least 10 of the time 2 The facility for re charging the smartphones The Samsung Note has a reasonably long lasting battery but if it is used continuously it may need to be charged once a day in other circumstances however it may last 2 4 days between charge Of course to make use of the data anaylsis provided via the cloud computing program the local health authority or whichever organization or hospital is autho
9. inical guidance to medical professionals worldwide All its activities are overseen by an International Editorial Board of distinguished leaders in the field under the chairmanship of its Editor in Chief President of The international Federation of Gynecology and Obstetrics FIGO To contact The Global Library of Women s Medicine please email publishercontact glowm com DEFINING THE PROGRAM Introduction The MOTHER Initiative is a completely new and original program that makes use of the latest advances in mobile technology and cloud computing to help midwives save mother s lives It is based principally on the use of large smartphones that midwives can carry with them at all times and which will enable them to do the following things e Create a detailed health record of every pregnant woman that they examine e Update that record easily throughout pregnancy and early infant life e dentify instantly whenever a woman is overdue for a pre natal check up e Receive an automatic reminder if a woman fails to attend a pre natal check up the woman also receives an automatic reminder e Access each woman s health record instantly and at any time ALSO e Have instant access to a wide range of clinical guidance designed to provide the midwife with on the spot help when no other assistance is available e Educate and inform patients on basic health matters with animation and film sequences The Objectives of The MOTHER Initiative Too many
10. iod and is programmed to send out reminders both to the midwife and the woman herself whenever an appointment is overdue The Information Module requires NO connectivity to the local phone network all the resources that it makes available are pre loaded onto each phone prior to distribution These resources are therefore live on the phone and are instantly available to the midwife anywhere and at anytime The Contact Module that enables phoning texting and also email messaging does require connectivity via the local phone network to be available in exactly the same way as with any ordinary mobile phone Contact Cloud computing the key to patient tracking and data analysis The Central Management System CMS for 7he MOTHER Initiative is hosted on an internet cloud and can be accessed remotely by anyone who Is provided with the secure access code The system stores all the data that it receives from each midwife and uses it to calculate when the next appointment is due As a result it is able to identify when any patient is overdue and to send out an alert to the relevant midwife and an automatic reminder to the patient herself by a text to her mobile phone if she has one The CMS is also able to present the data it receives to the local health authority in any format that is required Thus the local health authority can view the patient records of every midwife and receive a detailed analysis of pregnancy and chil
11. ng the midwife to enter data about each new woman patient very simply on her special mobile smartphone As will be demonstrated later this is a simple process that can be done conveniently and rapidly HEALTH CENTRE Once she has entered this data the midwife will always have all the relevant information about that woman instantly available at her fingertips As importantly the program will automatically remind her when that woman is due for another check up what is more it will also automatically remind the woman herself assuming that she has a simple black and white mobile phone which many now do Every time the women attends for another check up her record can be immediately accessed by the midwife and the results of the check up can be added to her existing health record In consequence her full pregnancy record is always available to the midwife who will be able to refer to it in order to plan appropriate treatment strategies wherever necessary The program also covers the actual period of childbirth and the early post natal weeks At every stage the midwife can monitor the mother and maintain a full record of both her progress and that on the newborn infant The program then continues to keep track of the infant for immunization purposes for 36 weeks to ensure that it receives the appropriate vaccinations and to automatically remind the midwife and the mother whenever vaccinations are overdue Supporting the b
12. nt information itemized in the Registration Number 7 ae _ first protocol Tap the black box Patient Family Name A Close and Submit to store this Given Name information permanently Home Address Contact Phone Number Birth Year Date Registered First Day of Last Menstrual Period Due Date 4 lf the woman being examined is a returning patient attending for a prenatal examination select this icon Then select her name from the list and open her record This will now already contain the information required about her that was listed when she was first registered plus the information recorded from any subsequent examination she may have had Review All Patients 5 Then select the box on the Report Form marked First Antenatal Visit 14 18 weeks or tap one of the three other boxes below if she is attending for a later examination The box will then open to reveal all the tests that should be carried out at that examination Many of these can be completed by simply using the slider or selecting the square with the correct information Occasionally you will have to use the keyboard on the smartphone to fill in a specific item Tip To make the entries easier hold the phone horizontally i e on its side so that the Report Form Is larger You can also use the special pencil that is incorporated into the smartohone to tap on individual keys if you find this easier 6 When you have finished comple
13. r signs during pregnancy Increased ability of midwives to manage difficult obstetric conditions or emergencies Better understanding by patients of the actions that they can take to improve their pregnancy and childbirth Greater patient compliance with required postnatal immunizations Availability of sophisticated and detailed data aiding local health authorities to improve evidence based provisioning and planning Closer clinical contact between midwives and their local health authorities and or hospitals All of which should result in e Fewer maternal deaths e Less mothers suffering from post natal complications and disabilities e Healthier infants e Better informed and supported midwives Part 2 HOW TO OPERATE THE PROGRAM This section is designed to provide a lt Logout Home Screen Step by step guide to operating The MOTHER nitiative effectively 1 Switch on the phone and then enter your security number es Information 2 The MOTHER Program will start automatically There will be a brief title screen followed by the first Menu screen with 3 choices indicated by these icons To record the progress of a patient or to register a new one 1 Select the Reporting Module by tapping on the first icon Reporting 2 Individual Patient Record 2 Then select Individual Patient Record 3 If the women being examined is aes apime a new patient complete the basic patie
14. rized to access the data needs to have access to the internet since The MOTHER Initiative program is largely self supporting no other facilities equipment or features are required Other considerations Confidentiality he medical records of all patients are private and should be confidential with the data entirely unavailable to unauthorized third parties With 7he MOTHER nitiative because each smartphone requires a separate and distinct password before it can be opened the information it holds should be more secure than with traditional paper based systems which anyone can view Of course if the smartphone is stolen or lost it can be blocked remotely as soon as its loss is reported and no access to the phone of any kind then remains possible In the same way access to the cloud based data base is stricly controlled by confidential log in codes lf the circumstances require it is also possible to encrypt all the data thus making it very difficult or impossible to read even if access to the data was to be achieved Security Since smartphones are comparatively small it is always possible that one might be lost or even stolen In such circumstances the smartphone in question can be blocked remotely thus making it virtually useless and rendering all the data and other items on it permanently unobtainable by anyone To reduce any security risk the smartphones are provided in simple belt pouches that are unobtrusive in appe
15. t room but may be better heard using earphones in noisy surroundings To use the smartphone to contact other medical professionals 1 2 Select the icon marked Contact Decide whether you want to phone or text and select accordingly Reporting Review All Patients Information Contact 11 PART 3 THE INFORMATION MODULE A guide to the support resources available on the smartphone 1 To access the wide range of practical information that is available on The MOTHER Initiative smartphone tap the icon marked Information You will then have instant access to a whole range of useful resources NB No connectivity is ever required in order to be able to view these they have all been pre loaded onto the smartphone and are therefore always available any time and anywhere Information The resources that are available will be listed as follows What these resources feature 1 Pregnancy 2 Tutorials m Exynos Maternity Tool maa calculator B A series of 7 short aegele Rule y F An easy to use oua n visual presentations digital calculator designed to for instantly Saar reinforce midwives calculating the ipene previously learnt correct childbirth i knowledge due date and Days 6 about basic obstetric other significance care procedures dates 3 Visual Guides A series of 6 highly illustrated sequences summarizing essential guidance for practical clinical man
16. ting the Reporting Form select the black Close and Submit box and the data will then be saved and it will also automatically be sent via the mobile phone network to the central data storage point of the cloud computing program NB f there should happen to be no phone connectivity at that moment then when connectivity is next established the phone will automatically send the data at that time 7 Repeat this process whenever the patient returns for another prenatal examination Close amp Submit HOW TO OPERATE THE PROGRAM continued 8 After childbirth and during the following 48 hours complete the short Reporting Records that are provided in exactly the same way 9 Later complete the Vaccination records in exactly the same way whenever the mother brings the baby back for its vaccination The patient s childbirth record is then complete and all the data will be permanently stored on the central cloud computing program providing important information for the local health authority and or the regional hospital How do you look at all your patient s records 1 Select the Reporting Module by Back Report Screen tapping on the first icon 2 You will then see this screen 3 Tap the icon Review all patients and a list of all your current patients will appear Tap any name you wish to review and their records will appear To close a patient s record tap the black button m
17. to the program and additional information resources can be added to the phone remotely at a later stage if these are required but that is not likely to be relevant in the initial Eaa testing period Fisk Complications A v This means that the whole reporting system for patients is immediately available for use and once connectivity has been established with the appropriate local network provider it can be used at any time In practical terms it should be noted that the Reporting Module of the program does not need constant connectivity to be usable it will function perfectly well if connectivity is available as little as 10 of the time it simply means that data entered will not be updated to the central server until the connectivity is available at which stage it will happen automatically a Hypeensen es S The Reporting Module simply transfers all data that is entered via the local mobile phone network to the internet where a cloud computing program stores it This program not only analyses all the data but makes it available to the midwife and to the local health authority at any time the midwife will view it on her smartphone whilst the local health authority can access it via a secure internet link to the cloud based program Based on the data that it receives the cloud based program follows the progress of each woman patient throughout pregnancy childbirth and the early neonatal per
18. usy midwife Midwives often work in challenging circumstances quite frequently without immediate access to the support of an expert physician At the same time they may be presented with a wide range of obstetric problems and emergencies some of which they may have little experience of handling The MOTHER nitiative has therefore been designed to provide them with instant access to a wide range of learning and revision resources that will reinforce midwives previous learning They are practical easy to understand and offer useful on the spot assistance in managing some of the clinical challenges that midwives often face J The resources include special tutorials on key obstetric emergencies such as pre eclampsia sepsis and postpartum hemorrhage short skills videos demonstrating the practical management of procedures such as vacuum extraction shoulder dystocia and neonatal resuscitation 10 minute clinical films on many childbirth related issues as well as expert clinical texts and many other resources In addition there is even a range of short highly visual picture SAMSUNG animations with voice commentary that midwives can show to their patients to educate them about pregnancy childbirth and early infant care Because these animations are highly visual and are accompanied by voice commentaries they can be fully understood even by patients who are unable to read Finally this module of 7he MOTHER nitiative also
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