Item | Choice | Selection |
---|---|---|
Level of delay | 1 = Maternal social (community level) | |
2 = Infrastructure service organization | ||
3 = Care | ||
4 = Infrastructure and care | ||
5 = All of above | ||
6 = No delay | ||
Contribution of the suboptimal care to the foetal death | 1 = Unlikely | |
2 = Possibly | ||
3 = Likely | ||
Final grading | Grade 0 -No suboptimal care identified | |
Grade I -Suboptimal care, identified but unlikely to have contributed to the fatal outcome, different management would have made no difference to the outcome | ||
Grade II -Suboptimal care identified and might have contributed to the fatal outcome. Different management might have made a difference to the outcome. | ||
Grade III -Suboptimal care identified and is likely to have contributed to the fatal outcome. Different management would reasonably be expected to have made a difference to the outcome. A clearly avoidable factor implying that the adverse outcome could have been prevented. | ||
Overall suboptimal graded 0, 1, II or III according to above definition | ||
Do you think there was sufficient information available to assign a final grade in this case | 1 = Yes 2 = No | |
Do you consider likely that this death was preventable? | 1 = Yes 2 = No | |
Number of panel member.................. | Date.............................. |