A Collaboration of Providers and Registered Nurses on Early Assessment and Identification of Patients with Risk Factors for Postpartum Hemorrhage

Abstract

Poster Presentation Purpose for the Program To prevent harm to the woman, health care providers and nursing staff collaborated to implement early identification triggers for women at risk of postpartum hemorrhage (PPH). Audit information was collected from six women who experienced PPH in May 2014. The obstetric units consist of 16 beds in the labor and delivery unit and 15 beds in the mother/infant unit in a community‐based medical center. During the audits, the chief of obstetrics and the administrative director questioned if the hemorrhages could have been prevented. Proposed Change Nursing staff receive education on PPH, and a hemorrhage cart is accessible on the individual units. Provider involvement became essential as concern was voiced over lack of patient information during physician hand‐off. Literature review took place and evidence was presented during a perinatal collaborative meeting consisting of physicians, nurses, quality representatives, and the risk manager. The Maternal Safety Bundle for Obstetric Hemorrhage published by the American College of Obstetricians and Gynecologists guided creation the program. Quarterly, nursing staff are taught to recognize PPH. Early recognition and prevention of PPH were ranked as top priorities that fueled the implementation of the project. Implementation, Outcomes, and Evaluation Education was performed with health care providers and nurses on a trigger tool constructed for women at risk of PPH. During initial assessment of the woman in triage or labor, the nurse is able to identify medium or high risk of PPH by using a laminated risk assessment tool found at each bedside. The trigger tool includes risk factors from the antepartum period, admission to labor and delivery, and the intrapartum period. At any time during changes in levels of care, the woman can be identified as being at medium or high risk for PPH, and a two‐dimensional magnet will placed on the doorframe outside her room. Continuous evaluation is performed to ensure trigger tool and visual cues are used. Implications for Nursing Practice The magnet is a visual cue for nursing staff and other health care providers to indicate that a woman is at risk of PPH. The visual cue is useful when entering the room of a woman who is giving birth or when performing postpartum assessment of a woman with whom the provider is not familiar. The provider is now alerted to an increased risk of hemorrhage. Nursing staff appreciate the visual cue when a call bell is activated.