Quality Improvement in Maternity Care: PPH Safety Bundles

This project was designed to create the curriculum for disseminating the new post-partum hemorrhage (PPH) safety bundle to hospitals across the State of Utah. A bundle is a set of actions that when performed collectively have demonstrated to improve patient outcomes. The Council on Patient Safety in Women's Health Care, a national workgroup representing all major women's health care organizations, released a statement that the PPH safety bundles should be implemented in all states. However, this large-scale change must be achievable for hospital units. The purpose of this project was to design an educational series on the components of the safety bundle and provide education to hospitals across the state on how to implement the safety bundle. PPH is the leading cause of preventable maternal deaths, accounting for 11.3% of all pregnancy-related deaths in 2011 in the US. PPH is a major concern because the incidence has increased by 26% from 1994-2006 in the United States (U.S.). PPH is especially challenging for hospital providers and staff because it occurs in about 2-3% of births in the U.S., so hospitals may be unprepared for the rare, but potentially deadly event of a PPH. The Utah Department of Health (UDOH) launched a statewide effort to assist hospitals with implementation of the safety bundle titled the Every Mother Initiative (EMI) and involved a panel of experts on PPH. Despite this call for universal implementation of the safety bundle, many facilities across the urban and rural areas of Utah are not using all elements of the OB hemorrhage safety bundle. To support these changes, the Institute for Healthcare Improvement endorses the use of the Plan Do Study Act cycle, an approach to accelerate healthcare improvement. Lastly, the adult learning theory, when applied to curriculum development, can result in positive learning outcomes. The objectives of this project were to develop a comprehensive curriculum that facilitates hospital providers and staff in implementing the OB hemorrhage safety bundle, pilot the curriculum using available video conferencing technology, and assess participant satisfaction with the curriculum content after four sessions. The platform used for the video conferencing technology is called ECHO (Extension for Community Healthcare Outcomes) and it allows for multiple users to videoconference simultaneously. Therefore, a curriculum overview was created for all 13 ECHO sessions, followed by the conduct of an ECHO session covering the topic of quantitative blood loss measurement and active management of third stage of labor. In addition, participant satisfaction was evaluated with a questionnaire for the first four meetings that took place from October 12, 2015 until November 24, 2015. The results of the questionnaire indicated that respondents were satisfied with each of the first four ECHO sessions. The results demonstrated that 100% of participants felt the sessions were a valuable resource for providing better patient care (n=11). This project recognized that ECHO technology could be a successful platform for promoting the PPH safety bundle statewide. There is a clear need for hospitals to begin implementing the PPH safety bundle, but this large-scale change is best implemented when it is broken down into manageable parts. The curriculum created in this project allows for manageable change for hospital providers and staff.