Assessment of quality of care in postpartum wards of Shaheed Beheshti Medical Science University hospitals, 2004

Abstract

Despite 77 per cent antenatal care coverage and 90 per cent skilled attendant at delivery, adjusted maternal mortality in Iran is 76 per 100,000 births. Low quality of maternal health services is one cause of maternal morbidity and mortality. However, few and limited studies have been devoted to the quality of postpartum care in Iran. This study aims to assess quality of care in postpartum wards of Shaheed Beheshti Medical Science University hospitals to show weakness and gaps areas in the care procedure for future improvement intervention programs. It is a descriptive study to assess quality of care in postpartum wards of Shaheed Beheshti Medical Science University hospitals, in 2003. Using quota sampling, 60 healthy women were recruited for the study. Data were collected using three forms including a questionnaire with demographic and obstetrics questions, a check-list for the postpartum care and education quality assessment. Control of vital signs, uterus assessment, perineum assessment, leaving bed, urinary system assessment, digestive system assessment, breast examination, extremities assessment, psychological assessment, as well as education about perineum self-care, breast-feeding, infant care, education before discharge and educational method. Validity and reliability of the questionnaire and checklist were assessed prior to use. Data were analyzed using SPSS. Results showed compatibility of provided postpartum care with the standards as follows: method of patient's education (52.68 per cent); control of vital signs (43.21 per cent); education about breast-feeding (26.06 per cent); care in getting out of bed (25.83 per cent); psychological care (19.36 per cent); urinary system assessment (16.66 per cent); education about perineum care (13.12 per cent); uterus assessment (10.6 per cent); digestive system assessment (9.69 per cent); patient's education before discharge (7.99 per cent); education about infant's care (7.81 per cent); perineum assessment (6.72 per cent); breast examination (1.11 per cent); and assessment of extremities (0.81 per cent). The study demonstrated that weak postpartum care was provided in 82 per cent of cases but also that mothers were satisfied with provided care in all domains of care. Mothers were very satisfied with facilities and less satisfied with personnel interaction with their visitors in hospital. There was no significant correlation between quality of services and clients' satisfaction (Spearman test, p < 0.05). For the first time in Iran, this study has evaluated quality of care in postpartum wards of hospitals based on the defined standards. The study provided a defined standard for postpartum care, which is necessary for regular monitoring and evaluation and so evidence-based intervention programs to improve the system of care. It was also postulated that mothers' satisfaction with care is not always a good indicator of services quality.