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Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. The chosen measures will help to determine whether an impact is being made (primary outcome), whether the intervention is actually being carried out (process measures), and whether any unintended consequences ensue (balancing measures).

Below are some recommended measures to use, as appropriate, to track your progress. In selecting your measures, consider the following:

  • Whenever possible, use measures you are already collecting for other programs.
  • Evaluate your choice of measures in terms of the usefulness of the final results and the resources required to obtain them; try to maximize the former while minimizing the latter.
  • Try to include both process and outcome measures in your measurement scheme.
  • You may use different measures or modify the measures described below to make them more appropriate and/or useful to your particular setting. However, be aware that modifying measures may limit the comparability of your results to others.
  • Posting your measure results within your hospital is a great way to keep your teams motivated and aware of progress. Try to include measures that your team will find meaningful and exciting (IHI, 2012).

For more information on measuring for improvement contact the Canadian Patient Safety Institute Central Measurement Team at measurement@cpsi-icsp.ca

Outcome Measures

  1. Per cent of patients with vaginal delivery (with and/or without instrumentation) who had postpartum hemorrhage within 24 hours of delivery.
  2. Per cent of patients with vaginal delivery (with and/or without instrumentation) who had postpartum hemorrhage within 24 hours to six weeks of delivery or discharge, whichever occurs first.
  3. Percentage of patients with a C-section delivery who had a postpartum hemorrhage.
  4. Percentage of patients with vaginal delivery (with and/or without instrumentation) who required any of the following interventions:
  • Manual removal of placenta.
  • Uterine balloon tamponade (i.e. commonly known as a Bakri balloon) or uterine packing, embolization.
  • Blood or blood product.
  • Use of Activated Factor VII.
  • Initiation of massive transfusion protocol.
  • Going to the operating room AFTER the delivery (e.g. D&C, exploration, repair).
  • Postpartum hysterectomy.

5.    Rate of maternal death due to postpartum hemorrhage.

Process Improvement Measures

  1. Per cent of obstetrical patients assessed for special considerations and risk of hemorrhage at the time of admission.
  2. Per cent of patients assessed for risk of hemorrhage throughout labour.
  3. Per cent of patients with vaginal delivery (with and/or without instrumentation) who had active management of the third stage of labour (AMTSL).
  4. Per cent of eligible patients undergoing vaginal delivery (with and/or without instrumentation) who received a uterotonic agent.
  5. Per cent of patients with vaginal delivery (with and/or without instrumentation) who delivered their placenta(e) within 30 minutes (or 60 minutes if no active bleeding).
  6. Per cent of patients with vaginal delivery (with and/or without instrumentation) delivering a premature newborn (<37 weeks) for whom cord clamping was performed up to 60 seconds after delivery.
  7. Percentage of patients with vaginal delivery (with and/or without instrumentation) who had prompt and careful examination of the birth canal and repair of lacerations.
  8. Percentage of patients assessed at least once per shift for risk of hemorrhage during the postpartum period.
  9. Percentage of patients who had ongoing monitoring for signs and symptoms of secondary PPH.