Date of Graduation

Summer 8-7-2018

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Nancy Taquino

Abstract

Problem: Postpartum hemorrhage (PPH) is one of the leading causes of severe maternal morbidity and mortality. It is unpredictable and can occur with or without identified risk factors. A postpartum hemorrhage can happen rapidly, therefore it is important for the team to be trained and prepared to recognize and respond quickly to the situation, by quantifying blood loss at deliveries.

Context:The California Maternal Quality Care Collaborative (CMQCC) has created a toolkit to better prepare maternal child health teams for readiness, recognition, response, and reporting when a hemorrhage occurs. This program was rolled out on the unit in 2015 resulting in a dramatic decrease in the postpartum hemorrhage rate, yet the unit was not able to sustain the changes.

Intervention: 100% of staff from all disciplines were retrained with an educational presentation of evidence-based practice on quantifying blood loss and a review of postpartum hemorrhage medications. Education, skills stations with new scales and a weighing worksheet, followed with a hemorrhage drill were completed. The team was asked to begin quantifying with a birth pause after the neonate’s delivery. The expectation was to quantify at every delivery.

Results: Since the completion of retraining and the roll out of the new equipment, there has been an increased adherence to the practice expectations, from 60% to 80%. The team is practicing the birth pause after the delivery of the neonate and quantifying blood loss. The fallouts for quantifying blood loss were emergency and precipitous deliveries, as the birth pause was not done.

Conclusion: The collaborative efforts of the Family Birth Center team made this project a success. Sharing the evidenced-based “why” of a practice change, along with unit data motivated the team to adhere to the quantification process. With support from leadership and the unit-based council teams the sustainability of this project has great potential and feasibility. The practice changes made are a standard of care, based on CMQCC recommendations to ensure the patient has the safest and highest quality of care during their stay. The team will continue the quality improvement work until it becomes a standard of practice and a part of the daily culture in order to have a positive effect on morbidity and mortality of our perinatal population.

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