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Table 4 Agreed Metrics and Indicators Following Midwifery Consensus Meeting

From: Identifying and prioritising midwifery care process metrics and indicators: a Delphi survey and stakeholder consensus process

Metric (n = 18)   Indicators (n = 93)
Midwifery Plan of Care 1 A midwife’s plan of care is evident and reflects the woman’s current condition including referral where appropriate
2 Appropriate midwifery care based on the assessment and plan is reordered
Booking 1 The woman’s name and healthcare record number are on each page/screen
2 All previous pregnancies and outcomes are recorded
3 Past medical/surgical/family/genetic/social/medication (as appropriate) histories are recorded
4 The allergy status is recorded
5 Infection status /alert is recorded
6 The blood pressure, and gestation at booking is recorded
7 There is evidence of assessment of antenatal risk factors recorded
8 Whether a blood transfusion is acceptable to the woman is recorded
9 There is evidence of assessment for mental health illnesses recorded
10 There is evidence of routine inquiry for domestic violence recorded
11 There is evidence that infant feeding has been discussed with the woman and recorded
12 There is evidence that health information relating to pregnancy has been given and recorded
Abdominal examination (after 24 weeks gestation) on current or last assessment 1 Abdominal inspection findings are recorded
2 Palpation-Fundal height in cms (where appropriate) is recorded
3 Palpation-Lie is recorded
4 Palpation-Presentation (where appropriate) is recorded
5 Palpation-Position (where appropriate) is recorded
6 Palpation-Engagement (where appropriate) is recorded
7 Palpation-Fetal activity (if present) is recorded
8 Auscultation-Fetal heart rates-Use of Pinard or hand held Doppler with a record of fetal heart rate in beats per minute (BPM)
Intrapartum fetal Wellbeing 1 There is recorded evidence of fetal heart monitoring with Pinard/Doppler on initial assessment
2 When using intermittent auscultation, the fetal heart is recorded at least every 15 min in the 1st stage of labour and at least every 5 min in the 2nd stage of labour
3 There is recorded evidence of date and time of infant’s birth in the labour record
4 Colour and volume of liquor are recorded
Intrapartum fetal wellbeing cardiotocography (CTG) 1 There is recorded evidence of indication for cardiotocography (CTG)
2 The date/time is validated and recorded at the start of CTG
3 The woman’s name and hospital number are recorded on the CTG by the midwife
4 The maternal pulse is recorded on the CTG strip on commencement of the CTG tracing
5 There is recorded evidence of systematic CTG interpretation occurring hourly (baseline, variability, accelerations, decelerations, uterine activity and plan of care)
6 There is recorded evidence that CTGs of concern have been reviewed by the senior midwife and/or obstetrician
Intrapartum Maternal wellbeing 1 There is recorded evidence of recording of maternal vital signs during labour according to the woman’s condition
2 A narrative is recorded at least hourly, to provide a record of the woman’s condition
3 Indication for vaginal examination is recorded
4 Consent to perform vaginal examination is recorded
5 There is recorded evidence of abdominal examination prior to vaginal examination.
6 There is evidence of systematic record keeping of the findings of all vaginal examinations
7 There is recorded evidence that a discussion has occurred with the woman about her care to include birth preferences
8 There is recorded evidence of contraction assessment at least every 30 min
9 There is recorded evidence of date and time of onset of each stage of labour
10 The name and designation of the person professionally requested to review the woman is recorded (as appropriate)
11 Indication for amniotomy is recorded
12 Consent for amniotomy is recorded
13 Indication for administration of oxytocin is recorded
14 Consent for administration of oxytocin is recorded
15 There is recorded evidence that oxytocin infusion has been reduced or stopped when uterine tachystystole is present
16 Where a CTG is of concern, there is recorded evidence that the oxytocin infusion was reduced or discontinued and a medical review was undertaken
17 There is recorded evidence of findings of assessment for perineal trauma
18 Where perineal repair is necessary and is performed by midwife, there is recorded evidence of repair
19 There is recorded evidence of estimated blood loss at birth
20 The date, time and method of birth are recorded
Risk assessment for venous thromboembolism (VTE) in pregnancy and the puerperium 1 There is recorded evidence of venous thromboembolism (VTE) assessment on admission
2 There is recorded evidence of VTE assessment postnatally
Immediate post birth care 1 Maternal vital signs are recorded on the IMEWS chart, prior to transfer to the postnatal ward
2 Maternal urinary output is recorded
3 Skin to skin contact is recorded
4 Breast feeding initiation time is recorded for a woman who chooses to breastfeed
5 Neonatal condition at birth (live, neonatal death, fetal death) is recorded
6 Findings of initial systematic examination of the newborn is recorded
Communication (Clinical Midwifery Handover) 1 Mother- Identification of risk factors in handover is recorded
2 Baby- Confirmation of identify band checking is recorded
3 Baby- Gender of newborn is recorded
4 Baby- Security tag is recorded as present and active
Pain management (other than labour) 1 Woman’s response to actions taken to reduce pain are recorded
Infant feeding 1 Method of infant feeding is recorded
2 Assessment of effectiveness of baby feeding is recorded
3 The actions taken if feeding is ineffective are recorded
Postnatal care (daily midwifery care processes) 1 There is recorded evidence of ongoing postnatal education being offered to the woman
2 There is recorded evidence of daily assessment of the mother (as per national health care record/local policy)
3 There is recorded evidence of how well the woman is coping postnatally
4 There is recorded evidence of daily assessment of the neonate (as per national health care record/local policy)
Post birth discharge planning for home 1 Discharge date and time are recorded
2 The name of midwife completing discharge is recorded
3 The destination of the woman is recorded on discharge
4 Referral for professional skilled services (e.g. lactation consultant, physio, social work, speciality clinic, if required) is recorded
5 There is recorded evidence of neonatal pulse oximetry screening having been performed (if appropriate)
6 There is recorded evidence of discharge advice/discussion on health and wellbeing of self and baby
Medication administration 1 The allergy status is clearly identifiable on the front page of prescription chart.
2 All prescribed medication is administered in accordance with local and national policies, procedures, protocols and guidelines (PPPGs)
Medication, Storage and Custody (excluding MDAs) 1 A registered midwife is in possession of the keys for medicinal product storage
2 All medicinal products are stored in a locked cupboard or locked room
MDA Drugs 1 MDA drugs are checked & signed at each changeover of shifts by midwifery staff
2 Two signatures are entered in the MDA drug register for each administration of an MDA drug
3 The MDA drug cupboard is locked and keys for MDA cupboard are held by designated midwife
4 MDA drug keys are kept separate from other medication keys
Intravenous fluid therapy 1 Fluid balance charts are completed accurately and totalled
Clinical Record Keeping 1 All entries are dated and timed (using 24 h clock)
2 All written records are legible, in permanent ink and signed
3 All entries are in chronological order
4 All abbreviations/grading systems are from a national or local approved list/system
5 Alterations/corrections are as per HSE standards and recommended practices for healthcare records management
6 Recorded care provided by midwifery students is countersigned by a registered midwife