4.

0 CRITERIA AND STANDARDS

Indicator of Care

Criteria

Target Level of Target Standard

Performance

Structure

Gestational Diabetic
Registry

There should be a
100%
Gestational
Diabetic Registry in
the health clinic.

There should be a
Gestational Diabetic
Registry in the
health clinic

Written management
protocol

There should be at 100%

least 1 written
management
protocol for
diabetes mellitus in
the health clinic

There should be a
written management
protocol for diabetes
mellitus in the clinic

Glucometer

There should be at 100%

least one functional
glucometer in the
health clinic.

There should be a
functional
glucometer in the
health clinic.

Blood HbA1C level 80%

should be measured
and recorded at
least once
throughout the
gestational period
of patient with
gestational
diabetes.

At least 80% of
Gestation Diabetic
Mother have blood
HbA1C level
measured and
recorded at least
once throughout
their antenatal
follow up in Health
Clinic.

Process

HbA1C level

Blood pressure level

Blood pressure

100%

Blood pressure
measurement and
recording during
every antenatal visit
should be done in all
pregnant women
with Gestational
Diabetes.

should be measured
and recorded
during every
antenatal visit in
pregnant women
with Gestational
Diabetes.
3

Weight measurement

Weight should be
measured and
recorded at every
antenatal visit.

100%

All pregnant women

with Gestational
Diabetes should
have their weight
measured at every
antenatal visit.

Urine dipstick
performed

Urinalysis for
proteinturia and
glucose is
performed at every
antenatal visit and
recorded.

100%

All mothers who are

diagnosed with
gestational diabetes
have routine
urinalysis performed
at every antenatal
visit and recorded.

Risk assessment for

Gestational Diabetes
done at first antenatal
visit/ booking and
recorded. Example of
risk factor:
First degree relative
with diabetes

Risk assessment for 80%

Gestational
Diabetes carried out
for all pregnant
women at first
antenatal visit and
recorded

At least 80% of
pregnant women
have been assessed
for the risk of
developing
Gestational Diabetes
and recorded.

OGTT done as
90%
early as first
antenatal visit or
within 16-18 weeks
in pregnant women
with high risk for
Gestational
Diabetes

OGTT should be
carried out as early
as first antenatal
visit or within 16-18
weeks in at least
90% of pregnant
women with high
risk for Gestational
Diabetes.

BMI>27 kg/m2
Previous unexplained
intrauterine death
Previous
macrocosmic baby
weight 4kg
History of congenital
anomalies
Previous pregnancy
with GDM
Recurrent vaginal
infection
Glycosuria at the first
or any prenatal visit
6

Oral Glucose Tolerance

Test (OGTT) as
screening for
Gestational Diabetes

Re-evaluation of high
risk pregnant women
who initially tested
negative.

Re-evaluation of
80%
high risk pregnant
women who
initially tested
negative with
OGTT performed at
least once within 4
to 6 weeks later or
at 24 to 28 weeks.

Re-evaluation of
Gestational Diabetes
with OGTT
performed at least
once within 4 to 6
weeks later or at 24
to 28 weeks should
be done in at least
80% of high risk
pregnant women
who initially tested
negative.

Blood sugar profile

Blood sugar profile 80%

should be recorded
at least once every
month during
antenatal follow up.

At least 80% of
pregnant women
with Gestational
Diabetes should
have their blood
sugar profile
recorded at least
once during their
antenatal visit.

Referred to a dietician

Referral to dietician 80%

for nutritional
counseling should
be done within a
month after
gestational diabetes
is confirmed.

At least 80% of
mothers who are
diagnosed with
gestational diabetes
are referred to
dietician for
nutritional
counseling within a
month after
diagnosed.

1
0

Insulin therapy started if Insulin therapy

diet control failed.
started within 1-2
weeks interval if
Failed diet control is
diet control failed.
defined as failure to
achieve 2 consecutive
satisfactory blood sugar
profile.

80%

At least 80% of
patient who had
failed diet control
are started on
insulin therapy
within 1-2 weeks
interval.

Outcome

Target level for prepradial or 2 hour

postprandial of blood
sugar profile achieved.

Blood glucose level 70%

during pre-pradial,
or 2 hour
postprandial
measured should
achieved the target
level which are
5.3 and 6.7
respectively for the
last three
measurement
during the
gestational period.

At least 70% of
pregnant women
with gestational
diabetes mellitus
should have
achieved the target
blood glucose level
of pre-pradial or 2
hour postprandial
which are 5.3 and
6.7 respectively
for the last three
measurement during
the gestational
period.

Blood pressure level of

140/80 mmHg
achieved

Blood pressure
level should be
140/80 mmHg for
all antenatal follow
up visits.

70% of the blood

pressure level
should be 140/80
mmHg for all
antenatal follow up
visits.

70%

Development of
maternal complication
during perinatal period
such as:

70%

At least 70% of
mother did not
develop
complication during
perinatal period due
to gestational
diabetes mellitus.

Development of foetal
There should be no 70%
complication during
foetal complication
perinatal period such as: develop during
perinatal period due
Macrosomnia
to gestational
diabetes mellitus.
Shoulder dystocia

At least 70% of
neonates did not
develop
complication during
perinatal period due
to gestational
diabetes mellitus.

Lower
segment caesarian
section

There should be no
maternal
complication
develop during
perinatal period
due to gestational
diabetes mellitus.

Perineal
Trauma

Preeclampsia

Polyhydramni
os

Prolonged
labour
4

Stiltbirth
Neonatal
Hypoglycemia

DATA ENTRY
Pt No
Patients Registration No.

Age

Race

HbA1c level

Blood pressure measurement

Weight measurement

Urina dipstick performed

Risk assessment for Gestational Diabetes done

at first antenatal visit/ booking and recorded
Oral Glucose Tolerance Test (OGTT) as
screening for Gestational Diabetes
Re-evaluation of high risk pregnant women
who initially tested negative.
Blood sugar profile

Referred to a dietician

Insulin therapy started if diet control failed.

Target level for pre-pradial or 2 hour

postprandial of blood sugar profile achieved.
Blood pressure level of 140/80 mmHg
achieved
Development of maternal complication during
perinatal period

Development of foetal complication during

perinatal period

7.0 APPENDIX
7.1 Gant Chart

Month
Week
Topic selection and approval

Meeting with supervisor

Literature review and proposal

development
Proposal submission

Preparing work for audit

Data collection and entry

Data analysis

Writing report

Report submission

April 2016
1

May 2016
4