| Description |
Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and the primary cause of maternal death on the day of birth, occurring in 2-3% of live births in the United States. Postpartum hemorrhage is defined as a cumulative blood loss of greater than or equal to 1000 mL or the presence of hypovolemic symptoms within 24 hours of delivery. Delayed response contributes to preventable deaths, as symptoms may not appear until 15-30% of blood volume is lost. Risk assessment tools aid in identifying at-risk individuals, but PPH remains unpredictable, necessitating vigilant monitoring and preparedness among obstetric care providers to ensure timely intervention and improved maternal outcomes. This project evaluates the implementation of an updated postpartum hemorrhage protocol with the aim of decreasing postpartum hemorrhage rates by optimizing workflow and improving compliance with evidence-based practices. Local Problem: The project was conducted in a rural community hospital with an eight-bed labor, delivery, recovery, and postpartum unit that operates with limited staffing and resources, increasing the risk of delayed intervention in postpartum hemorrhage. An updated postpartum hemorrhage protocol was implemented in June 2024 but had not been successfully adopted. Key stakeholders include hospital administration, obstetric providers, and nursing staff. Methods: A pre-intervention survey assessed the staff's current practice and confidence in preventing and managing postpartum hemorrhage and identified perceived barriers when managing postpartum recoveries. Weekly chart reviews were conducted pre- and post-implementation to evaluate the staff's compliance with the updated protocol. Average monthly and quarterly postpartum hemorrhage rates were analyzed to evaluate overall trends throughout 2024. A post-intervention survey assessed compliance, feasibility, usability, and overall satisfaction with implementing the evidence-based postpartum hemorrhage protocol. Interventions: Staff were educated at a staff meeting before the updated evidence-based postpartum hemorrhage protocol was implemented. Hemorrhage guidelines were displayed at the nurses' desk and on the unit hemorrhage cart for quick recollection. Workflow improvements included placing scales in all delivery rooms, providing dry item weight references, and creating medication kits for rapid access to postpartum hemorrhage medications. Results: Following staff education, rapid cycle chart reviews showed improved compliance with quantitative blood loss (QBL) documentation, increasing from 80% to 92.9% at delivery and 45% to 75% during recovery. Postimplementation surveys revealed that 73.3% of staff were satisfied with the updated protocol, and 100% planned to continue using it in clinical practice. Hospital data showed a continuous fluctuation in postpartum hemorrhage rate from 4.8% in the first quarter and 1.10% in the second (pre-implementation) to 1.01% in the third and 3.6% in the fourth quarter (post-implementation). Challenges included resource limitations, staff and provider compliance, the need for staffing adjustments, and more frequent training to sustain improvements. |
