Purpose for the program: Operation Red Flag was developed to ignite and renew our interdisciplinary team approach to the prevention and management of postpartum hemorrhage (PPH).  The purpose was to provide the opportunity for all disciplines involved in responding to a postpartum hemorrhage to review research, cases, and collaborate to develop evidence-based guidelines for the prevention and management of PPH.

Proposed change: Operation Red Flag was developed to allow an interdisciplinary team to provide input in the development of evidence-based guidelines, training, and order set and to provide role clarification.

Implementation, outcomes and evaluation: Operation Red Flag was initiated in early 2011. The team has conducted case reviews and modified our guideline as needed. We will continue to review cases as they arise and plan to implement simulation based training for ongoing evaluation and training.

Implications for nursing practice: Nursing plays a critical role in the assessment, communication and implementation of a plan to prevent and manage postpartum hemorrhage.

Keywords: It is critical that nurses identify risk factors that increase the patient's risk for postpartum hemorrhage and are familiar with nursing interventions key to the assessment, prevention and management of postpartum hemorrhage.  It is the responsbility of our medical facility teams to establish an interdisciplinary team approach to ensure we are all working together to improve patient outcomes.

Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and is increasing in incidence (CMQCC, 2010). Severe bleeding is the most significant cause of maternal death within the first 24 hours of delivery (ACOG, 2006).  Deaths from hemorrhage consistently rank at the top of the most preventable list with 70-92 percent of deaths judged preventable (CMQCC, 2010). Hemodynamic changes that occur in the postpartum period may fluctuate significantly as they reflect results of blood loss sustained at delivery and the body’s compensation to peripartum hemorrhage (Mandeville & Troiano, 1999).   Postpartum hemorrhage (PPH) is a potentially life-threatening event that can occur with little warning and may be unrecognized until the patient is symptomatic (Poole & White, 2005).   Our OB/GYN team identified the need to initiate a collaborative working group to establish policies, procedures, and education for the assessment, management, and prevention postpartum hemorrhage.     Early recognition and response to a PPH are critical to optimal management  and stabilization of a patient with PPH (Poole & White, 2005).    Our interdisciplinary team focused on assessment, communication, and establishing a guideline and order set to be initiated on immediately following assessment of postpartum hemorrhage.