Postpartum hemorrhage (PPH) is an infrequent but potentially life-threatening event that may not be recognized until the mother’s condition is critical.  Early recognition, prompt treatment, and effective teamwork are the critical skills necessary to minimize maternal mortality and morbidity.  The Joint Commission recommends the use of interdisciplinary simulation drills to train staff, improve teamwork, refine protocols, and identify systems problems.

Proposed change:

This project developed and implemented an interdisciplinary postpartum hemorrhage response initiative (PPHRI) and a multifaceted training program to improve patient safety and outcome.  

Implementation, outcomes and evaluation:

An interdisciplinary team of nurses, physicians, educators, pharmacists and information technologists collaborated to design strategies which improve the coordination of PPH response within our institution.  The PPHRI project standardized staff training, management protocols, order sets, and emergency response algorithms. In addition, the team developed a standardized PPH Supply Bag and Omnicell^® Drug kit.  Interdisciplinary development of the project created both nurse and physician buy-in.

All obstetric nurses and physicians participated in the training, which included an online self-study module, an in-situ simulation drill with video debriefing, an estimated blood loss exercise, a cognitive quiz, and a post-activity survey.

The online self-study module combined core knowledge and current evidence based practice with standardized system processes.  The program utilized the following mnemonic device ABCD's of Postpartum Hemorrhage Management:  A - assess, alert, and assemble, B - breathing, C - circulation, control bleeding, administer uterotonics, D - determine the cause of bleeding and document effectively

Simulation training focused on the demonstration of appropriate clinical management as well as the utilization of effective teamwork and communication skills.  Video debriefing allowed staff to recognize areas of success and areas of deficiency.  

Key successes among team members were:  improved recognition and early treatment of PPH, enhanced coordination of care, and more timely administration of uterotonics.  Over time, these successes are expected to lead to an improvement in overall patient outcome.

Implications for nursing practice:

The multifaceted approach for interdisciplinary training increased staff knowledge and confidence related to the recognition and response to postpartum hemorrhage.  Simulation training provided a forum for staff to integrate multi-professional knowledge, refine skills, and perfect team member roles in responding to this low-volume, high-risk obstetric emergency.

Keywords:

Postpartum Hemorrhage

Multifaceted Approach

Interdisciplinary

Education and Training

Patient Safety

High Fidelity Simulation