Sunday, Sep 26 - Expo Hall Opening
Sunday, Sep 26 - Job Fair
Monday,
Sep 27 - AWHONN's Block Party
Sunday, September 26, 2010
Title: From Dazed and Confused to Empowered: A New Graduate's Solution for Managing Postpartum Hemorrhage
Discipline: Women’s Health (WH), Professional Issues (PI), Childbearing (CB)
Learning Objectives:
Submission Description:- Describe risk factors, signs, and symptoms for postpartum hemorrhage.
- Outline nursing interventions and critical supplies needed to effectively manage a postpartum hemorrhage.
- Describe the process for developing a postpartum hemorrhage box and how to incorporate the PPH Box into unit culture to improve patient safety and staff confidence.
Postpartum Hemorrhage (PPH) is defined as an estimated blood loss greater than 500mL following vaginal birth or greater than 1,000mL following ceserean birth. More than half of all maternal deaths occur within 24 hours of delivery, most commonly from excessive bleeding (ACOG). Nurse clinicians play a critical role in early identification and intervention with PPH.
Case Study
A 32 year old, para 3003 was admitted to the postpartum unit (PPU) 3 hours postpartum. She gave birth to a full term baby boy, weighing 4000 grams, apgars 9 and 9. It was an uncomplicated birth, with an estimated blood loss (EBL) of 300mL. Thirty minutes after admission to the PPU, the nurse discovered the patient sitting in a pool of blood. The patient's fundus was boggy, at U+2. The nurse massaged the fundus, observing a steady stream of bright red blood. Vital signs were within normal limits. The OB team was notified and a certified nurse midwife (CNM) arrived to manage the clinical emergency. A bimanual exam was done, and three baseball-sized clots were removed. Heavy bleeding continued. A urinary catheter was placed to empty the patient's bladder and a speculum exam was completed. Long sponge sticks and radiopaque gauze pads were used to evacuate more clots. An IV infusion of 1000mL Normal Saline with 20 units of Oxytocin was started, and the patient’s bleeding resolved. The total EBL was 700mL.
Reflections of a New Graduate
From the above description one might assume this was an organized, efficient management of a PPH, but not exactly. As a new graduate, this was my first experience with PPH. The CNM asked for supplies which were not familiar to me, and not available on the PPU. An experienced labor and delivery nurse arrived and assumed care of the patient. The situation left me feeling powerless and excluded from the management of this patient. Other postpartum nurses related similar experiences. I knew a change was necessary in our management of PPH on the PPU.
I collaborated with a CNM to determine the required supplies for management of PPH, and created a PPH Tool Box containing most of these supplies. Medications, IV supplies, and urinary catheter kits were excluded from the box due to expiration dates, charging purposes, and size. To overcome the obstacle of not having all supplies in the toolkit, I created a “supply card”, listing items that may be obtained from the supply pyxis, with door numbers delineating each supply location by Pyxis door number. The card is attached to the PPH Tool box and can be given to support personnel during a PPH. The PPH Box is locked and checked with the emergency equipment.
I also created an educational program for my peers, outlining PPH risk factors, signs and symptoms, nursing actions, and case scenarios. The staff on the PPU now feel empowered in the event of a PPH. This poster outlines the management of PPH, development of a PPH Tool Box, and peer education as a solution to empower nurses and improve patient safety on the PPU.
