Date of Graduation

Spring 5-20-2022

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


MSN project

First Advisor

Lisa Brozda


Problem: The microsystem for maternal-child healthcare in 2020 had 5.9% of deliveries progress to a postpartum hemorrhage. In 2021, the percentage of deliveries that progressed to a postpartum hemorrhage increased to 12.3%. The nearly two-fold increase in postpartum hemorrhage occurrence led to the creation of the Quality Improvement (QI) initiative to identify postpartum hemorrhage at an earlier stage. The QI initiative aims to extend the quantitative blood loss (QBL) measurement beyond labor and delivery, and support identification of postpartum hemorrhage in the postpartum period.

Context: The microsystem that this quality improvement project occurred on were three postpartum units in a Bay Area Hospital. The microsystem was made up of postpartum nurses, antepartum nurses, nurse team leaders, nurse managers, nurse educators, obstetricians, anesthesiologists, nursing assistants, and unit clerks. The Bay Area Hospital averages approximately 4,500 births per year. QBL was initiated in the Bay Area Hospital’s labor and delivery unit in February 2021.

Interventions: The quality improvement team implemented quantified blood loss (QBL) collection with a gravimetric scale (Triton scale) in the postpartum units to identify postpartum hemorrhage and improve notification time to the provider. The postpartum nurses collected QBL at the first two voids for vaginal deliveries and at four and eight hours for cesarean section deliveries. Daily EPIC electronic health records (EHRs) were audited to reinforce education.

Measures: Staff surveying was conducted before implementation of the quality improvement project and after implementation with a mid-point survey. Education on Triton use was delivered to postpartum nurses in-person and through virtual modalities.

Results: After the implementation of QBL in the postpartum units, 90% of postpartum nurses felt comfortable using the Triton scale to collect QBL. During the month of April 2022 in which chart audits were conducted, there was a significant decrease in the number of postpartum hemorrhages compared to April 2021. In addition, chart auditing revealed that 82.9% of the postpartum hemorrhages occurred in labor and delivery, while 17.1% of postpartum hemorrhages occur in postpartum.

Conclusion: The quantification of blood loss is an evidence-based method to accurately collect cumulative postpartum blood loss and should be used for all postpartum patients and extend beyond the labor and delivery measurement of QBL to determine accurate information related to primary postpartum hemorrhage. In a Bay Area Hospital, the implementation of QBL was introduced in three postpartum units. Through and through education efforts allowed postpartum nurses to gain the confidence to properly collect QBL for all postpartum patients and identify the occurrence of postpartum hemorrhages that occur in the postpartum units.