Interdisciplinary Team Development of a Comprehensive Protocol and Toolkit for Management of Postpartum Hemorrhage

Hemorrhage associated with pregnancy and childbirth continues to be a major cause of maternal morbidity and mortality. Hemorrhage was the cause of 17.2% of pregnancy related mortality in the United States from 1991-1999. Current data reveal that morbidity due to hemorrhage is one of the key maternal outcomes with the greatest variability among hospitals. Identification of patients at risk, development of preventive strategies, prompt recognition of excessive blood loss and rapid intervention are essential to optimize patient outcomes.  The bedside perinatal nurse plays an important role in ensuring early recognition, systematic assessment, and timely response to major obstetric hemorrhage.  Potentially serious outcomes can be minimized in situations with immediate implementation of interventions, prompt physician and specialty notification, rapid access to resources and clear interdisciplinary communication.

An interdisciplinary team including members representing three hospitals within a system identified the need for a standardized, rapid approach to identification and management of postpartum hemorrhage. The group collaborated to develop a comprehensive evidence based protocol and toolkit for the management of the patient at risk for or experiencing postpartum hemorrhage. Components of the toolkit include algorithms for prenatal screening and counseling, intrapartum assessment and identification of risk factors, establishing the OB hemorrhage emergency “code”, standardized order sets and treatment options, clarification of interdisciplinary team roles and identification of hospital capabilities.

This poster will present the protocol and toolkit and describe the development process and the implementation experience within the three affiliated hospitals.