A Multidisciplinary Team Approach to Management of Postpartum Hemorrhage

Abstract

Purpose for the Program This hospital is a teaching facility with a diverse population of families. It is the only free‐standing women's hospital in the state and averages 6200 births per year. Despite being a groundbreaker in many ways, the rate of postpartum hemorrhage (PPH) was almost equal to the state and national averages. There was no standardized approach to the management of PPH, and with an increasing urgency to improve PPH outcomes, the nursing staff made the decision to make a change. The goals were to develop a PPH protocol, decrease the rate of PPH‐related transfusions, and decrease the number of PPH‐related adverse outcomes such as peripartum hysterectomies. When any of these events occur, often the length of stay increases as well. Proposed Change To implement a culture of safety and enhance interdepartmental teamwork. A team approach was needed to develop and utilize a standardized protocol. Although historically physicians and nurses did not participate in education together, educating all members of the health care team at the same time was essential. Implementation, Outcomes, and Evaluation A focused, multidisciplinary team representing every clinical department in the hospital formed a PPH committee and was facilitated by nursing staff. Each member of the team took ownership by using the plan, do, check, act (PDCA) quality improvement methodology. The protocol was developed; didactic learning and 87 simulation classes took place with participation from more than 83% of the entire staff and physicians. The rate of PPH‐related transfusions decreased from 3.5% in 2009 to 2012 to 2.8% in 2014. Peripartum hysterectomies decreased from an average of 4.1/year in 2009 to 2012 to two in 2013 and two in 2014 year to date. Before participating in the simulation, the mean confidence level in identifying and managing a PPH was 2.6 (N = 307) on a Likert‐type scale (1 = not confident at all, 4 = very confident). One month after the simulation, 90% of the participants said they felt either confident or very confident. Implications for Nursing Practice Nurses can be the change agents in an environment that has not embraced a true team approach, but it takes well‐coordinated effort and physician champions. Nurses at the bedside can be empowered to initiate evidence‐based practice approaches to improve outcomes and the overall quality of life for mothers and their families. This hospital is a teaching facility with a diverse population of families. It is the only free‐standing women's hospital in the state and averages 6200 births per year. Despite being a groundbreaker in many ways, the rate of postpartum hemorrhage (PPH) was almost equal to the state and national averages. There was no standardized approach to the management of PPH, and with an increasing urgency to improve PPH outcomes, the nursing staff made the decision to make a change. The goals were to develop a PPH protocol, decrease the rate of PPH‐related transfusions, and decrease the number of PPH‐related adverse outcomes such as peripartum hysterectomies. When any of these events occur, often the length of stay increases as well. To implement a culture of safety and enhance interdepartmental teamwork. A team approach was needed to develop and utilize a standardized protocol. Although historically physicians and nurses did not participate in education together, educating all members of the health care team at the same time was essential. A focused, multidisciplinary team representing every clinical department in the hospital formed a PPH committee and was facilitated by nursing staff. Each member of the team took ownership by using the plan, do, check, act (PDCA) quality improvement methodology. The protocol was developed; didactic learning and 87 simulation classes took place with participation from more than 83% of the entire staff and physicians. The rate of PPH‐related transfusions decreased from 3.5% in 2009 to 2012 to 2.8% in 2014. Peripartum hysterectomies decreased from an average of 4.1/year in 2009 to 2012 to two in 2013 and two in 2014 year to date. Before participating in the simulation, the mean confidence level in identifying and managing a PPH was 2.6 (N = 307) on a Likert‐type scale (1 = not confident at all, 4 = very confident). One month after the simulation, 90% of the participants said they felt either confident or very confident. Nurses can be the change agents in an environment that has not embraced a true team approach, but it takes well‐coordinated effort and physician champions. Nurses at the bedside can be empowered to initiate evidence‐based practice approaches to improve outcomes and the overall quality of life for mothers and their families.