COLOR CODING SYSTEM AT PRIMARY HEALTH CARE SYSTEM IN MALAYSIAHudayah binti Yahaya101303125group B1

colour coding systemadvantagedisadvantage

IntroductionThe risk approach system using colour codes.Implemented in Malaysia since 1989 and revised in 1991. It grades all antenatal mothers according to the level of severity of risk factors.

AimsTo enable the rural health staffs to differentiate between cases they could continue to see and those that should be referredto refer cases to the appropriate level of care without delayTo ensure appropriate category of staffs treats the case without delay

How it works?

The color codes

colourplace of careofficer responsibleplace of deliveryRedhospitalspecialistmedical officer (o n g)hospitalYellow hospital/ health centermedical officerhospitalGreenhealth centrehouse officer nursecommunity nursehospitalhealth centrecommunity nurseabchome

White code 1Mothers have to deliver in hospital

Criteria:1) Primigravida2) Age < 18 years or > 40 years3) Spacing < 2 years or > 5 years4) Gravida 6 and above5) Height < 145cm6) Home surrounding not suitable7) Single mother

White code

White code 2Mothers are not at risk for any complicationsAllowed to deliver at home

Criteria:1) Gravida 2 to 52) No past obstetric problem3) No past medical problem4) Home environment is good5) Height > 145cm6) Baby weight >2kg, 18 years or 37 weeks or

Green CodeMothers have risk that may complicate the pregnancyAntenatal care is monitored by medical and health officerCriteria:Rh negativeWeight before pregnancy/during booking 80kg during bookingMedical problem: psychiatric/physical illness except diabetes and hypertension

Past gynaecological problem/operation Smoking, alcohol, drug addicts Unsure LMP Recurrent abortion Past obstetric history of :LSCS , PIH , eclampsia , diabetes , 3rd degree perineal tear , placenta accreta , PPH , Instrumental delivery , prolong labour pain More than 1 fetus BP 140/90 mmHg without proteinuria Disproportionate SFH

Yellow codeMothers have to be monitored regularly on basisIf there is further complication, the mother is tagged red and will be hospitalised.Refer to specialist/OBG hospital or clinic within 48 hours

Criteria:Mother with HIV +Mother with HepB +Blood pressure > 140/90 mmHg or 32 weeks of pregnancyPost term > 7 days of EDDHb

Red zoneIndicates that mothers are at a very high risk and to be hospitalised immediatelyCriteria:Pre-eclampsia (high BP with albuminuria) or has symptoms of BP > 160/110 mmHgEclampsiaIschemic heart disease during pregnancy with sign and symptoms (Shortness of breath/palpitation)

Shortness of breath while doing mild activity.Uncontrolled diabetes with presence of ketone in urine (>+1)Bleeding per vagina during pregnancy (including abortion)Abnormal fetal heart rate :FHR < 110/min during or after 26 weeksFHR > 160/min after 34 weeks

Anemia with symptomsPremature contractionRupture of membrane without contractionSevere asthmatic attack

AdvantagesAppropriate measures taken without delayAppropriate distribution of health staffInvolvement of family members, community and health personnel in combating maternal/ infant mortality and morbidityProvides health education, information and motivational programme.

Disadvantages

Can cause psychological stress to the patientNot accurate (error in classifying)*Studies done in 1997 by Department of Comunity Health, UKM showed only 56% of the assigned codes were accurate.Need to train nursing personnelHigh maintenance and inconvinienceRequires full commitment from all to succeed

ReferenceDid We Do it Right? An Evaluation of the Colour Coding System for Antenatal Care in Malaysia, J Ravindran, FRCOG*, K Shamsuddin, Dr PH** , S Selvara;u, DPH***, 'Department of Obstetrics & Gynaecology, Seremban Hospital, 70300 Seremban, Malaysia, **Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, "'Family Health Division, Ministry of Health,Kuala LumpurInovasi Keibuan Selamat 1998 Sistem tali berwarna pada kad antenatal kes berisiko, pejabat kesihatan Sik Kedah Darulaman.