In our patient population, postpartum hemorrhages are a high risk yet a very low volume event and as it being a military teaching hospital we have a large number of staff turn over so we felt that we needed to come up with a comprehensive training strategy.  The decision was initiated after many discussions and debriefings following some of the hemorrhages that occurred on our unit. 

The process first started simply by the nurses feeling empowered and thus putting together a postpartum hemorrhage cart and creating go-by pocket cards.  Their reasoning: they found that during each hemorrhage the doctors and nurses were in need of the same items and it took too much time to run around and obtain them.  Our previous situation required somebody to run and individually locate foley kits, iv items, fluids, sterile gloves, med administration items, and oxygen supplies. 

They also felt that having the go-by cards would help to standardize nursing care and to alleviate the anxiety that often occurs during a hemorrhage.  They took the concept already developed by the command and chose to make cards to fit on our name-tags so they would always be with us.  They felt this would help the nurses anticipate what to do and assist in guiding the doctors.

While working on the go-by cards it was decided that the whole process needed to be formalized. A formal action plan was developed which incorporated a review of the policy, decision on the content of go-by cards, literature review and creation of staff in-service and finally data collection on the incidence of postpartum hemorrhages on the postpartum unit (greater than 2 hours post delivery).   

The plans are that the cart (to remain in consistent location) will continue to be used for improving staff response in addition to all staff having their own pocket cards.   In order to comply with Joint Commission and in an order to maintain stock, the cart remains locked until the need arises for the use of the cart.  If the cart is used and the seal is broken, the cart will be restocked at that time and a new seal obtained.  The cards will be passed out to all staff members who have completed their training and are to be worn on their command ID badges to be used as a guide during postpartum hemorrhages.  In addition, regular mock postpartum hemorrhages will be conducted throughout various shifts in an effort to continually evaluate the effectiveness of the changes and staff knowledge of the changes.  In order to standardize the evaluations, an evaluation form will be developed for the mock postpartum hemorrhages.

We will use the standardized evaluations forms, continuous feedback and will also use debriefing sessions among staff involved in actual postpartum hemorrhages to determine any further changes or adjustments needed for the supply cart, the cards, or the policy.

This will become part of formal training for all new staff members and recurring training will be provided for current staff members.