We Can Save Her: Managing Postpartum Hemorrhage

Sunday, June 15, 2014

Title: We Can Save Her: Managing Postpartum Hemorrhage

Allison Reynolds, BSN, RNC-MNN , New Family Center, Baylor University Medical Center, Dallas, TX
Laura Briggs, RN , New Family Center, Baylor University Medical Center, Dallas, TX

Discipline: Childbearing (CB), Women’s Health (WH)

Learning Objectives:
  1. Compose a nursing guideline addressing postpartum hemorrhage risks, nursing interventions & management
  2. Create an emergency postpartum hemorrhage supply cart to utilize during emergency situations
  3. Develop simulation scenarios/drills for managing hemorrhage and estimating blood loss
Submission Description:
Purpose for the program: Postpartum Hemorrhage (PPH) is the leading cause of maternal death.  Unfortunately, the incidence of PPH remains high.  Nurses must be prepared to identify signs and symptoms of PPH, recognize maternal compromise and deal with hemorrhage promptly.

Proposed change: Incorporate protocols and training to better equip RNs to handle postpartum hemorrhage.

Implementation, outcomes and evaluation: 1. The Women & Children’s Quality Committee drafted a nursing guideline addressing the management of PPH based on AGOG and AWHONN recommendations.  2. A 3-drawer cart was purchased and stocked with supplies identified as essential by experienced nurses and physicians.   The service-line pharmacist was consulted as to the best method to create and store an emergency medication box.  3.  The Simulation Coordinator drafted several PPH drills incorporating the nursing guidelines and emergency cart.  All staff RNs participated in annual simulation training.  All staff RNs completing annual competency training which included reviewing the PPH guideline and completing a test regarding content.

While the incidence of PPH has not decreased on the postpartum unit, the incidence of transfers to labor & delivery following bleeding episodes has decreased.

Nurses and Physicians both verbalized new found efficiency when dealing with PPH.  During emergency situations, many patients have commented how calm the staff are and how “everyone knew exactly what to do.” 

Implications for nursing practice: By identifying PPH promptly and providing swift interventions, maternal morbidity and mortality can be greatly reduced.

Keywords: Postpartum, Hemorrhage, Maternal Morbidity, Maternal Mort

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The Association of Women's Health, Obstetric and Neonatal Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.