Implementing Risk Assessment Screening Tool for Postpartum Hemorrhage upon Admission to the Postpartum Unit

Background: Postpartum hemorrhage (PPH) continues to remain the leading cause of maternal mortality and morbidity, with increasing numbers in the United States accounting for 11% of pregnancy related deaths (Watkins and Stem, 2020). Obstetric hemorrhage risk assessment screening should be performed upon admission to labor and delivery and postpartum to determine necessary interventions to prevent PPH (The Joint Commission, 2019). Local Problem: A quality improvement project was conducted at a community-based hospital women's center. It was determined that the PPH risk assessment screening tool was not being conducted upon admission to postpartum following delivery. Methods: Pre- and post-intervention surveys were conducted over an 8-week period of time to determine increase in PPH risk assessment charting. A simulation-based training was used to educate on PPH interventions and improve nurses' knowledge, skills and confidence for PPH management. Interventions: Educational flow charts and a checklist for interventions was provided for the unit to reference. Reminder cards were placed on all computer sites to reinforce PPH risk assessment charting. Weekly check ins by the project lead were done to evaluate feelings and compliance. Results: Over the course of the project, 197 patients were tracked, and the percentage of patients that had the hemorrhage risk assessment screening tool charted in their electronic medical record when transferred to the postpartum unit increased from 16% to 79%. Pre, post and follow-up surveys were conducted to review knowledge, usability and feasibility and mixed results were found. Priority of PPH assessment charting continued to remain a high priority. Knowledge of PPH improved from 46% to 64% from pre to follow-up surveys. Conclusions: Improved screening of PPH risk factors aided in nurses' early recognition of PPH, increased knowledge and anecdotally increased the confidence of the postpartum nursing staff. More research should be conducted to improve screening of PPH. Simulation based trainings should be included into annual training to enhance learning and PPH management