Implementation of a Postpartum Hemorrhage Safety Bundle at an Urban Safety-Net Hospital

Abstract

Background Postpartum hemorrhage (PPH) is a leading cause of preventable maternal morbidity and mortality. Standardized response to obstetric hemorrhage is associated with significant improvement in maternal outcomes, yet implementation can be challenging. Objective The primary objective is to describe the methodology for program implementation of the Alliance for Innovation on Maternal Health Safety Bundle on PPH at an urban safety-net hospital. Methods Over an 18-month period, interventions geared toward (1) risk assessment and stratification, (2) hemorrhage identification and management, (3) team communication and simulation, and (4) debriefs and case review were implemented. Hemorrhage risk assessment stratification rates were tracked overtime as an early measure of bundle compliance. Results Hemorrhage risk assessment stratification rates improved to >90% during bundle implementation. Conclusion Keys to implementation included multidisciplinary stakeholder commitment, stepwise and iterative approach, and parallel systems for monitoring and evaluation Implementation of a PPH safety bundle is feasible in a resource-constrained setting.

Cuidados de enfermeiros frente às hemorragias puerperais: revisão integrativa

“…No Quadro 1, são apresentadas as características dos artigos quanto ao ano/país, objetivo, delineamento, nível de evidência e principais resultados. Quatro estudos foram publicados em 2021; [34][35][36][37] seis, em 2020; [28][29][30][31][32][33] três, em 2019; [25][26][27] dois, em 2018; [23][24] cinco, em 2017; [18][19][20][21][22] dois, em 2015; [16][17] e um, em 2014. 15 Assim, destacaram-se os anos de 2017 e 2020, com a maioria das publicações.…”

“…Atualmente, tem-se introduzido nas unidades obstétricas o QBL, que utiliza um padrão na quantificação da perda sanguínea por meio do peso seco dos panos e absorventes e, posteriormente, o peso quando saturado, sendo utilizada para a pesagem a balança para recém-nascido já presente nas unidades. 28 Nos EUA, um hospital que educou seus enfermeiros e médicos a usar o QBL obteve a diferença média entre a perda sanguínea estimada e quantificada de aproximadamente 0,30 ml. No entanto, o valor foi diferenciado quando avaliado individualmente de acordo com profissional, visto que uma enfermeira que usou QBL para avaliar o sangramento de uma puérpera chegou ao valor de 600 ml de perda sanguínea, enquanto um médico da equipe que estimou a perda chegou ao resultado de 350 ml, o que favoreceu com que a equipe médica aceitasse a nova ferramenta.…”

Uptake and Adherence to National Guidelines on Postpartum Haemorrhage in Italy: The MOVIE before–after Observational Study

“…Research has explored potential effective strategies to enhance compliance and assess the implementation of PPH guidelines [ 17 , 18 , 19 , 24 , 25 ]. Quality improvement initiatives including health professionals training, risk assessment protocols, the adoption of flowcharts and checklists, clinical audits, and patient empowerment tools have been implemented with the aim of enhancing clinician’s skills, ameliorated care, and thereby preventing avoidable severe haemorrhagic events [ 18 , 25 , 26 , 27 ].…”

Reducing Hemorrhage-Related Maternal Morbidity Using Interdisciplinary Simulation Training

“…Simulation-based learning has been used as a tool to implement PPH bundles across the United States to combat the rising maternal morbidity and mortality associated with this preventable complication. 21 While there is literature that shows these simulations can improve teamwork and understanding of new protocols, there is little published evidence on its effects on patient safety and clinical outcomes. This study suggests that simulation education as an intervention may improve hemorrhage-related morbidity outcomes in a large tertiary center in a diverse epicenter of the population and can show a reduction in composite hemorrhage morbidity.…”

“…Simulation-based learning has been used as a tool to implement PPH bundles across the United States to combat the rising maternal morbidity and mortality associated with this preventable complication 21 . While there is literature that shows these simulations can improve teamwork and understanding of new protocols, there is little published evidence on its effects on patient safety and clinical outcomes.…”