Incorporation of Mean Arterial Pressure in Clinical Practice Using Quality Improvement Initiative

To increase the practice of measuring mean arterial pressure (MAP) in pregnant women during antenatal check-up from 0 to 70% by 6 months.

A quality improvement (QI) team ran multiple Plan-Do-Study-Act (PDSA) cycles. The process measure was two weekly assessments of improvement in MAP measurement. The outcome measure was the proportion of women started on aspirin. The pregnancy outcome of the low-risk and high-risk women were compared.

A total of 360 antenatal women were evaluated. With successive PDSA cycles, which included bridging knowledge gaps; involvement of a multidisciplinary team; involvement of supporting staff; application of software, the MAP measurement improved from 0 to 90% by the end of the study. Total 120/360 (33.3%) cases were deemed high risk based on the presence of maternal risk factors (OR -7.2 , C/I 1.43-36.50). The sensitivity, specificity, PPV and NPV of the test was 75.0%, 70.4%, 5.7%, 99.2% respectively. Total 14/120 (11.7%) cases at high risk of PE were started on aspirin. PE occurred in 6/106 (7.6%) women who were not on aspirin.

The successful incorporation of MAP measurement in routine clinical practice could be done in a busy public hospital using POCQI.