Interprofessional Review of a Postpartum Hemorrhage Protocol

Abstract

Problem: Postpartum hemorrhage, heavy bleeding that occurs after birth, is the leading cause of maternal morbidity and mortality worldwide, affecting up to 5% of all births. Rates of postpartum hemorrhage continue to rise in the United States, despite acknowledgement of this complication and its’ impact on maternal health. Emphasis has been placed on early identification of risk factors for hemorrhage and creation of protocols to improve interprofessional efficiency when managing a postpartum hemorrhage. Management of this complication requires interprofessional collaboration amongst healthcare professionals, including nursing staff, Certified Nurse-Midwives, obstetrician/gynecologists, anesthesia providers, and others. Project Aim: This Doctor of Nursing Practice quality improvement project aimed to: (1) develop an evidence-based protocol for PPH, which will: (a) increase early identification of postpartum hemorrhage after birth; and (b) improve interprofessional collaboration during an active PPH emergency. Project Method: This evidence-based protocol was developed based on the Iowa Model of Evidence-Based Practice to Promote Quality of Care and will identified women at greater risk for hemorrhage and outline an interprofessional postpartum hemorrhage protocol. A team of healthcare professionals, representing different healthcare professions that care for patients during postpartum hemorrhage, evaluated the protocol utilizing the AGREE II evaluation tool. Project Results: Surveys were distributed using RedCap with a sample of 26 participants: 22 (84.6%) registered nurses, three (11.5%) Certified Nurse Midwives and one (3.8%) obstetrician. Responses communicated a desire for a PPH protocol within this local community hospital. Survey responses and comments were used to revise the PPH protocol. Keywords: postpartum hemorrhage, hemorrhage, obstetric, maternal mortality, maternal morbidity, PPH, protocol, quality improvement