Management of postpartum hemorrhage in a rural hospital in Kenya: a best practice implementation project.

Abstract

Postpartum hemorrhage accounts for 34% of maternal deaths in Kenya. The World Health Organization guidelines on postpartum hemorrhage are not always followed despite being prominently promoted in hospitals. The objectives of this study were to assess the current practice of health workers in the prevention and management of postpartum hemorrhage and to implement strategies to promote best practice. A baseline audit with five evidence-based audit criteria was conducted using the Joanna Briggs Institute Practical Application of Clinical Evidence System. Strategies to improve compliance were implemented and a follow-up audit was carried out using the same data collection methods. Results of both audits were compared. The baseline audit showed that 90% of health workers were aware of the existence and location of the national guidelines. Almost two thirds (65%) of staff had received education on postpartum hemorrhage within the last two years. Only 30% had received specific training on the use of the guidelines and compliance with the guidelines was 0%. At the follow-up audit, the proportion of health workers who had received recent education on postpartum hemorrhage and specific training on the use of a protocol increased to 90%. The use and documentation of a protocol for postpartum hemorrhage increased to 100%. Compliance in prenatal risk assessment for postpartum hemorrhage decreased from 65% to 35%. Knowledge of the guidelines did not translate into their use during management of patients with postpartum hemorrhage. The introduction of a tool and staff education and training improved compliance.