Implementation of an Evidence-Based Hemorrhage Protocol at a Birth Center

Abstract

Maternal morbidity and mortality are on the rise in the United States. Postpartum hemorrhage is the leading cause of postpregnancy complications; however, early detection and management can minimize the effects of hemorrhage. To improve maternity care in the United States, evidence-based postpartum hemorrhage protocols and care bundles need to be implemented. On the basis of a risk analysis performed at a midwife-led birth center in Austin, Texas, staff determined that a comprehensive postpartum hemorrhage protocol needed to be developed and implemented. Based on the resources and limitations of the birth center environment, a care bundle was created. Postpartum hemorrhage kits were created that held all of the necessary materials needed in the event of a hemorrhage. The kits included intravenous catheters and fluids, lab drawing supplies, and a scale for accurately measuring blood loss. An easy-to-read reference list of uterotonic medications was created and placed on top of the kits for easy access. An evidence-based algorithm for interventions was created and placed on top of the kit as well. Last, a flowsheet was created for staff to document interventions. After implementation of the care bundle, staff evaluated its success by determining the amount of blood loss that occurred in postintervention hemorrhages. They also tracked the number of posthemorrhage complications and number of medically necessary transfers from the birth center that were related to hemorrhage, with the goal of complete elimination of complications and transfers. Comprehensive care protocols empower nurses to provide quality care for their patients in emergency situations. Quality improvement in hospital and birth center environments is necessary to improve maternity care. Development of evidence-based postpartum hemorrhage protocols is an essential step for quality improvement and can be a positive, nurse-driven change.