Implementation Of Care Bundle Research Articles

Implementation of nutritional care bundle is associated with improved growth in preterm infants born before 32 gestational weeks

ObjectiveTo evaluate whether implementing a nutritional care bundle is associated with growth and morbidity in very preterm (VPT) infants. Study designThis study compared 87 VPT infants (<32 gestational weeks) born 2018 (Before group) with 75 infants born 2020 (After group), treated at a single center in the Czech Republic. A nutritional care bundle was implemented during 2019. ResultsMedian gestational age (weeks) was 30.0 [IQR 27.6–31.1] for the Before group and 29.9 [IQR 27.9–30.6] for the After group. During postnatal days 1–14, parenteral fluid intake was significantly lower in the After group compared to the Before group and conversely for enteral fluid intake. Infants in the After group achieved full enteral feeds by postnatal day 14 (72.9 % vs. Before group 51.9 %). Weight z-scores decreased significantly less from birth to 36 weeks postmenstrual age in the After group (−0.8 [IQR −1.3 to −0.5]) compared to the Before group (−1.5 [IQR −2.0 to −1.2]). Head circumference z-scores decreased significantly less in the After group (−0.8±0.9) than the Before group (−1.6±1.1). Decreased rate of patent ductus arteriosus (PDA) requiring treatment was observed in the After group (P < 0.001). ConclusionsImplementation of a nutritional care bundle in VPT infants was associated with improved postnatal growth and may reduce treatment-requiring PDA.

Assessing the effect of implementing a central line care bundle on central line-associated bloodstream infections in a tertiary hospital in Saudi Arabia

Central line-associated bloodstream infections (CLABSIs) are severe bloodstream infections caused by catheter use and are often associated with a longer hospital stay, increased healthcare costs, and a higher mortality rate. However, catheter-related bloodstream infections can be successfully treated. It is essential that healthcare workers are aware of central line (CL) insertion and maintenance bundles to reduce and prevent the incidence of CLABSI. The objective of this study was to assess the impact of implementing CL care bundles on hospital-wide CLABSI incidence rates. This is a prospective study conducted at the King Faisal Specialist Hospital and Research Center in Saudi Arabia from January 2017 to December 2021. The research period was divided into two phases: the pre-intervention phase (January 1, 2017 to December 31, 2018) and the post-intervention phase (January, 2019 to December 31, 2020). During both phases, outcome variables, including CLABSI rate, were assessed. In the present study, the total number of CLABSIs is 439, of which 266 were in the pre-intervention phase and 173 were in the post-intervention phase. The overall CLABSI rate significantly decreased from 1.6±0.05 in the pre-intervention phase to 0.9±0.05 in the post-intervention phase. This decline in CLABSI was significant (p&lt;0.0001) across all hospital settings, including critical care and non-critical care units. The implementation of care bundles is essential and has been shown to significantly reduce CLABSI rates in nearly all participating units.

74 Reducing unplanned extubations in a level 3 neonatal intensive care unit - the nuts and bolts of UE bundle implementation

Abstract Background Unplanned extubations (UEs) are preventable adverse events that may lead to short term consequences (e.g. cardiopulmonary collapse) and long term sequelae (e.g. acquired airway injury, brain injury) for patients admitted to the Neonatal Intensive Care Unit (NICU). UE prevention care bundles have been demonstrated to reduce UE rates in NICUs; however, implementation of bundle elements is unit dependent. Objectives To describe the work of a UE Prevention Team in a Level 3 NICU with rising UE rates despite implementation of UE prevention bundle per Children’s Hospital Solutions for Patient Safety (SPS). Design/Methods A neonatologist / respiratory therapist pair was assembled in March 2022 to tackle rising UE rates in a 69 bed NICU. Contributing unit stressors included implementation of a new electronic health record, COVID-19 policies, and nursing shortages. Baseline UE rates were &amp;gt;3x the centerline for SPS network NICUs and likely underreported. Steps undertaken include: 1) daily audit to ensure reporting of all UEs, 2) structured post-event team debriefs, 3) unit education campaign to raise awareness of UE prevention and bundle elements, 4) prominent posting of last UE date and reporting on daily team huddle, 5) rapid UE case reviews and apparent cause analysis with reporting of findings unit-wide, 6) optimize endotracheal tube (ETT) securement methods, 6) enforce T2-T3 ETT tip position, 7) standardize x-ray frequencies and reporting, 8) trial of daily rounds ETT safety checklist. Results From rapid case reviews, apparent causes were determined to be incorrect ETT securement device sizing, taping method prone to loss of tape integrity in high humidity, high ETT positions, and inadequate ETT monitoring during high risk activities other than repositioning (invasive/painful procedures, diaper changes). Post-event structured debriefs and unit-wide vigilance increased reporting of UE events to 100%. UE rates fell from a peak of &amp;gt;4 UEs/month, &amp;gt;2.4/100 ventilation days to 1 UE/month, 0.465/100 ventilation days, a 80% reduction.(Figure 1) Most impactful interventions were standard x-ray reporting template in the electronic health record, reinforcing T2-T3 ETT tip positioning, correcting ETT holder sizing, and change in ETT method (Figure 2). Daily rounds checklist was not effective. UE reductions were achieved without changing patient ratios as nurse staffing shortages continued. Conclusion A nimble systems approach is needed to ensure success in implementation of UE prevention care bundles. Simple changes can be made to decrease UEs, guided by rapid case reviews.

Implementation of surgical site infection care bundle in patients undergoing gastrointestinal surgeries

PurposeSurgical site infection (SSI) is one of the frequent healthcare associated infections linked with significant morbidity, prolonged hospitalization, and death. SSI can be reduced by implementation of customized care bundle components as per standard guidelines. Hence this study was undertaken with the objective to implement care bundle in patients undergoing elective gastrointestinal surgeries and assess their impact on SSI rate. MethodsThe study was an interventional study conducted in the department of surgical gastroenterology for 8 months. Sample size was calculated to be 196 and only elective surgeries are included. CDC NHSN 2023 guidelines are used for surveillance of SSI and global guidelines for prevention of SSI was used for preparation of list of pre-operative, intraoperative and post-operative care bundle components and were implemented before the start of the study. ResultsOverall SSI rate and compliance to SSI care bundle in this study are 13.8% and 28.6%, respectively. When compared with the baseline SSI rate of 19.4%, there is reduction of 28.9% in SSI rate after the implementation of care bundle. Escherichia coli (54.2%) is the most commonly isolated organism. Care bundle non-compliant surgeries are associated with 2.3 times (relative risk-2.3) increased risk of SSI. There is fluctuating trend in compliance of care bundle and SSI rates across months. ConclusionThis study shows the importance of implementation of set of care bundle for prevention of SSI which can be customized and adapted for reducing SSI.

Effect of care bundles based on importance degree analysis on postoperative comorbid state, coping style and disease management ability of patients with coronary heart disease.

Coronary heart disease (CHD) is a significant global health concern, particularly among the elderly. While care bundles present a comprehensive strategy for clinical disorders, their application in CHD rehabilitation remains understudied. This research addresses this gap by investigating the effectiveness of care bundles in CHD patients. By analyzing important performance degrees, we aim to contribute valuable insights to bridge existing knowledge deficiencies. Our study strives to establish a theoretical foundation for the broader implementation of care bundles, potentially improving the quality of care and patient outcomes in CHD rehabilitation. This is a retrospective study. 360 patients with CHD who were admitted to our hospital from January 2019 to October 2022 were enrolled in this retrospective study and divided into the observation group (n = 180) and control group (n = 180) according to the different care that they received. All cases were given routine nursing after CHD operation, and the observation group was given care bundles on the basis of the analysis of important performance degrees. The perioperative indexes, self-management ability score, depression, anxiety, stress scale (DASS), coping styles, medical compliance and the incidence of complications were compared between the 2 groups. Aftercare, the time of hospitalization and getting out-of-bed in the observation group was notably shorter (P < .05). Aftercare, the scores of self-management ability and related dimensions in the observation group were notably higher (P < .05). After care, the score of depression (P < .001), anxiety (P = .003) and stress (P = .017) of the observation group were notably lower. Aftercare, the observation group face score was significantly higher than the control group (P = .005), while the observation group avoidance score (P = .028) and yield score (P < .001) were significantly lower than the control group scores. Aftercare, the compliance behavior of patients in the observation group was notably better (P = .013). Aftercare, the incidence of complications in the observation group was notably lower (P = .039). Care bundles based on the degree of importance analysis can play a positive role in postoperative comorbid state, coping styles and self-management ability of patients with CHD, which can improve the rehabilitation effects on patients.

Lack of health disparities during implementation of hospital-initiated care bundle among hospitalized adults with asthma

Lack of health disparities during implementation of hospital-initiated care bundle among hospitalized adults with asthma

Effectiveness of TRACHE Care Bundle Implementation on the Pediatric Nurses' Performance and Improving Pediatric Tracheostomy Management Safety

Effectiveness of TRACHE Care Bundle Implementation on the Pediatric Nurses' Performance and Improving Pediatric Tracheostomy Management Safety

Prevention of Central Line-Associated Bloodstream Infection via Quality Improvement

Introduction: The economic burden of CLABSIs is substantial, with each infection estimated to add between $45,000 to $55,000 to hospital costs. The aim of this systematic review was to synthesize the current evidence on the prevention of CLABSI through quality improvement initiatives. Methods: A literature search was conducted using the following electronic databases: PubMed, MEDLINE, CINAHL, Cochrane Library, and EMBASE. The search was limited to studies published in the last 15 years, to ensure the relevance and timeliness of the data. The inclusion criteria were strictly defined to select high-quality interventional studies. Included studies were those that focused on interventions for the prevention of CLABSI and were conducted in hospital settings. Studies were excluded if they were non-interventional (such as reviews, editorials, and opinion pieces), focused on populations outside of hospital settings, or did not provide clear outcome measures related to CLABSI rates. Results: A number of 8 studies were included with a common theme among the interventions was the implementation of comprehensive care bundles, which included components like staff education, hand hygiene protocols, and standardized catheter maintenance procedures. Comprehensive care bundles were particularly effective, with risk ratios (RRs) as low as 0.20 and 0.21, highlighting a reduction in infection rates by approximately 80%. Interventions involving antimicrobial catheters showed RRs ranging from 0.33 to 0.71, indicating a substantial decrease in CLABSI incidences. Moreover, staff training and education interventions resulted in RRs between 0.36 and 0.46, underscoring their importance in infection control. Conclusions: The review revealed a broad range of sample sizes and methodologies, underscore the critical role of multifaceted, context-specific approaches in significantly reducing the incidence of CLABSIs and improving patient safety in hospital settings.

Prevent Cardiac Surgery-Associated AKI by Perioperative Implementation of Care Bundles

Prevent Cardiac Surgery-Associated AKI by Perioperative Implementation of Care Bundles

Evaluation of an Evidence-Based Care Bundle for Preventing Hospital-Acquired Pressure Injuries in High-Risk Surgical Patients.

The aim of this study was to evaluate the effectiveness of an evidence-based care bundle to prevent perioperative pressure injuries. In a single facility, using a preintervention and postintervention quasi-experimental design, we compared the pressure injury incidence rate for two patient groups (ie, before and after care bundle implementation). The bundle included a variety of elements, such as educating patients, applying protection, controlling skin moisture, and using pressure-relieving devices according to the patient's risk. Before the intervention, patients received standard care before procedures that did not address risk for pressure injury development. The study involved a total of 944 patients, and the incidence of pressure injury was lower in the postintervention group than in the preintervention group (1.6% versus 4.8%; P<.001). However, the odds ratio was nonsignificant and therefore the clinical relevance of the bundle is unclear. Additional research with a control group and multiple sites is needed.

Implementation of Supportive Care Program to Decrease CLABSI in a Middle East Pediatric Hematology and Oncology Inpatient Unit.

Background: Central venous catheters (CVCs) support the administration of chemotherapy and other medications, blood products, fluids, and nutrient infusions, and reduce the need for peripheral blood sampling in children with cancer. CVC use is also associated with the risk of central-line-associated bloodstream infection (CLABSI). Despite the implementation of CLABSI care bundles, CLABSI prevention remains challenging. Method: This project implemented supportive preventive care interventions to decrease CLABSI in pediatric hematology/oncology patients in a tertiary hospital in the Middle East region. Interventions included bathing or skin care once daily, oral care twice daily, and ambulating patients three times daily. Parent and staff education materials were developed. The project moniker was Step 1-2-3, inspired by successful implementations of such measures in a U.S. cohort showing reduced CLABSI rates. The project used a mixed methods approach. We report outcomes through August 2022. Results: Pre-project (12/2019-05/2020) five CLABSIs occurred in the inpatient unit. Following the implementation of Step 1-2-3, Pediatric Oncology achieved 492 CLABSI-free days. Six CLABSIs then occurred over a short period of time between October 2021 and January 2022, which was associated with high levels of patient acuity and staff sick leave. The inpatient ward remained CLABSI-free from January 9, 2022, through August 2022. Discussion: Extended periods of CLABSI-free care in a pediatric hematology/oncology unit are achievable. A variety of factors contribute to the sustainability of being CLABSI-free. Data collection and analysis are important factors which aided in our understanding of our own CLABSI events.

Outcomes of Care-bundle Implementation for Children With Cancer and Suspected Bloodstream Infection in a Pediatric Oncology Unit in a Resource-limited Setting.

Bloodstream infections (BSIs) are a major cause of mortality among pediatric oncology patients in resource-limited settings. Effective, innovative strategies are needed to improve care and survival. In a pediatric oncology unit in Mexico, we retrospectively analyzed the risk factors for mortality related to BSI and the results of using a care-bundle intervention. The care-bundle consisted of a swift clinical evaluation, initial fluid-resuscitation support, obtaining blood cultures, and administration of effective empirical antibiotic therapy for suspected BSI. The outcomes of patients who received the care-bundle during a 12-month period were compared with those of patients treated with standard care during the 12 months preceding its implementation. The primary outcomes were BSI diagnosis, choice of antibiotics, and mortality. Of the 261 suspected BSIs treated with standard care, 33 (12.6%) infections were confirmed, and of the 308 treated with the care-bundle, 67 (21.7%) BSIs were confirmed. Thus, after implementation of the care-bundle, significantly more BSIs were diagnosed ( P =0.004), and BSI-related mortality was significantly reduced by 22.2% ( P = 0.035). Surgical resection and mechanical ventilation support were independently associated with BSI-related mortality, and receiving effective initial empirical antibiotic therapy was protective against mortality (odds ratio, 0.013; 95% CI: 0.002-0.105; P =0.001), which comprising cefepime plus amikacin or meropenem in 44 (80.0%) of the cases alive. Consistent use of a care-bundle with initial fluid resuscitation, obtaining a blood culture, and administering effective antibiotics to children with cancer and suspected BSI can decrease mortality.

Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis

BackgroundVentilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP. MethodsA systematic review and meta-analysis were performed. Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation (MV) for at least 48 h were considered for inclusion. Outcomes of interest were the number of VAP episodes, duration of MV, hospital and intensive care unit (ICU) length of stay, and mortality. A systematic search was conducted in the MEDLINE, the Cochrane Library, and the Web of Science between 1985 and 2022. Results are reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The PROSPERO registration number is CRD42022341780. ResultsThirty-six studies including 116,873 MV participants met the inclusion criteria. A total of 84,031 participants underwent care bundles for VAP prevention. The most reported component of the ventilator bundle was head-of-bed elevation (n=83,146), followed by oral care (n=80,787). A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles, compared with the non-care bundle group (OR=0.42, 95% CI: 0.33, 0.54). Additionally, the implementation of care bundles decreased the duration of MV (MD=−0.59, 95% CI: −1.03, −0.15) and hospital length of stay (MD=−1.24, 95% CI: −2.30, −0.18) in studies where educational activities were part of the bundle. Data regarding mortality were inconclusive. ConclusionsThe implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs. Their application in combination with educational activities seemed to improve clinical outcomes.

Barriers to Implementation of a Urinary Catheter Care Bundle for Critically Ill Patients with Cerebrovascular Stroke

Barriers to Implementation of a Urinary Catheter Care Bundle for Critically Ill Patients with Cerebrovascular Stroke

Impact of care bundles on the occurrence and outcomes of acute kidney injury among patients withST-segment elevation myocardial infarction.

Several reports suggested that compliance with acute kidney injury care bundles among hospitalized patients resulted in improved kidney and patient outcomes. We investigated the effect of acute kidney injury care bundle utilization on the incidence of acute kidney injury and renal outcomes in a large cohort of myocardial infarction patients treated with percutaneous coronary intervention. We included patients withmyocardial infarction admitted following percutaneous coronary intervention between January 2008 and December 2020. From January 2016, acute kidney injury care bundle was implemented in our cardiac intensive care unit. Acute kidney injury care bundle consisted of simple standardized investigations and interventions, including strict monitoring of serum creatinine and urine analysis, planning investigations, treatment, and guidance about seeking nephrologist advice. Patients' records were evaluated for the occurrence of acute kidney injury, its severity, and recovery, before and after the implementation of acute kidney injury care bundle. We included2646 patients (1941 patients in the years 2008-2015 and 705 patients in the years 2016-2020). Implementation of care bundles resulted in a significant decrease in the occurrence of acute kidney injury from 190/1945 to 42/705 (10-6%; p < 0.001), with a trend for lower acute kidney injury score > 1 (20% vs. 25%; p = 0.07) and higher acute kidney injury recovery (62% vs. 45%, p = 0.001). Using a multivariable regression model, the use of care bundles resulted in a 45% decrease in the relative risk for acute kidney injury (HR 0.55, 95% CI 0.37-0.82, p < 0.001). Among patients withST-elevation myocardial infarction, treated with percutaneous coronary intervention and admitted to our cardiac intensive care unit over the period January 2008-December 2020, compliance with acute kidney injury care bundle was independently associated with a significant decrease in occurrence ofacute kidney injury and withbetter renal outcomes following acute kidney injury. Further interventions, such ase-alert systems for acute kidney injury, could improve utilization of the acute kidney injury care bundle and optimize its clinical benefits.

What's New in Musculoskeletal Infection.

What's New in Musculoskeletal Infection.

Impact of care bundles on the occurrence and outcomes of acute kidney injury among myocardial infarction patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Among Patients with myocardial infarction hospitalized patients, deterioration of renal function resulting in acute kidney injury (AKI) is an important complication, associated with increased length of hospital stay, morbidity and mortality. Given large variation in care for AKI patients and poor outcomes of AKI, the interest in implementing care bundles for AKI is growing. Several reports suggested that compliance with AKI bundles among hospitalized patients resulted in better kidney and patient outcomes non, however, included acute cardiac patients. Purpose We investigated the effect of AKI care bundle (AKI-CB ) utilization on the incidence and renal outcomes of AKI in a large cohort of myocardial infarction patients treated percutaneous coronary intervention (PCI). Methods We Included ST elevation myocardial infarction (STEMI) patients admitted to the cardiac intensive care unit following PCI between January 2008- December 2020. From January 2016 AKI- CB was implemented in our cardiac intensive care unit. AKI-CB consisted of simple standardized investigations and interventions, reminding clinicians of the importance of early AKI detection, management, via strict monitoring of serum creatinine and urine analysis, planning investigations and treatment and guidance about seeking nephrologist advice. .Patients' records were evaluated for the occurrence of AKI, its severity, AKI recovery, length of hospital stay and long term mortality before and after the implementation of AKI-CB. Results 2646 patients were included (1945 patients in the years 2008-2015 and 705 patients in the years 2016-2020). Overall, 232 AKI episodes occurred within the study period (232/2646, 8.7%). Implementation of care bundles resulted in a decrease in the occurrence of AKI from 190/1945 ( 10%) to 42/705 (6%); P&amp;lt;0.001, with a trend for lower AKI score&amp;gt;1 (20% vs. 25% ; p=0.07), higher AKI recovery ( 62% vs. 45% , p=0.001) and reduction in the length of hospital stay ( 5.2± 6 days vs. 5.9 ± 5 days ; p=0.02). Over a median follow up period of 48 month, mortality was significantly lower following implementation of AKI-CB ( 3.7% vs. 5.8%,p=0.002,figure 1). Using a multivariable regression model, the use of care bundles resulted in a 45% decrease in the relative risk for AKI (HR 0.55, 95% CI 0.37-0.82, p=0.003; figure 2). Conclusion Among STEMI patients, compliance with AKI-CB was independently associated with a decrease in AKI occurrence and better renal outcomes following an AKI event. Further interventions are required to improve utilization of the AKI-CB.

An evaluation of the implementation of an intraventricular haemorrhage care bundle from a nursing perspective

The aim of this study is to explore the implementation and evaluation of a neonatal nursing intraventricular haemorrhage (IVH) care bundle, to determine areas for improvement in clinical practice. Overall, nurses felt confident in their knowledge about the implementation of the intraventricular haemorrhage care bundle and felt their nursing practice had changed as a result. An increase in nursing workload was reported by some which is exacerbated by shortages of neonatal nurses in the United Kingdom and should be considered during implementation. A cohesive teaching package with areas of ongoing learning is vital to avoid any confusion in the clinical setting, with guidelines and information packs available to staff. Nursing staff had an overall positive experience with the implementation of the intraventricular haemorrhage prevention care bundle and felt it significantly benefits neonates at risk of intraventricular haemorrhage and brings change in practice.

Recognition and Management of Hospital-Acquired Sepsis Among Older General Medical Inpatients: A Multi-Site Retrospective Study.

To assess accuracy of early diagnosis, appropriateness and timeliness of response, and clinical outcomes of older general medical inpatients with hospital-acquired sepsis. Hospital abstracts of inpatient encounters from seven digital Queensland public hospitals between July 2018 and September 2020 were screened retrospectively for diagnoses of hospital-acquired sepsis. Electronic medical records were retrieved and cases meeting selection criteria and classified as confirmed or probable sepsis using pre-specified criteria were included. Investigations and treatments following the first digitally generated alert of clinical deterioration were compared with a best practice sepsis care bundle. Outcome measures comprised 30-day all-cause mortality after deterioration, and unplanned readmissions at 14 days after discharge. Of the 169 screened care episodes, 59 comprised probable or confirmed cases of sepsis treated by general medicine teams at the time of initial deterioration. Of these, 43 (72.9%) had no mention of sepsis in the differential diagnosis on first medical review, and only 38 (64%) were managed as having sepsis. Each care bundle component of blood cultures, serum lactate, and intravenous fluid resuscitation and antibiotics was only delivered in approximately 30% of cases, and antibiotic administration was delayed more than an hour in 28 of 38 (73.7%) cases. Early recognition of sepsis and timely implementation of care bundles are challenging in older general medical patients. Education programs in sepsis care standards targeting nurses and junior medical staff, closer patient monitoring, and post-discharge follow-up may improve patient outcomes.

Factors influencing postpartum haemorrhage detection and management and the implementation of a new postpartum haemorrhage care bundle (E-MOTIVE) in Kenya, Nigeria, and South Africa

BackgroundPostpartum haemorrhage (PPH) is the leading cause of global maternal deaths, accounting for 30–50% of maternal deaths in sub-Saharan Africa. Most PPH-related deaths are preventable with timely detection and initiation of care, which may be facilitated by using a clinical care bundle. We explore influences on current PPH detection and management and on the future implementation of a new PPH bundle (E-MOTIVE) in low-resource, high-burden settings.MethodsSemi-structured qualitative interviews based on the Theoretical Domains Framework were conducted with 45 healthcare providers across nine hospitals in Nigeria, Kenya and South Africa, to identify barriers and enablers to current PPH detection and management and future implementation of a new PPH care bundle. Data were analysed using thematic and framework analysis. The Behaviour Change Wheel was used to identify potential interventions to address identified barriers and enablers.ResultsInfluences on current PPH detection and management fell under 12 domains: Environmental Context and Resources (drug and staff shortages), Skills (limited in-service training), Knowledge (variable understanding of the recommended practice), Behaviour Regulation (limited quality improvement culture), Beliefs about Consequences (drawbacks from inaccurate detection), Emotion (stress from the unpredictability of PPH), Social Influence (teamwork), Memory, Attention and Decision-making (limited guideline use), Social/Professional Role and Identity (role clarity), Beliefs about Capabilities (confidence in managing PPH), Reinforcement (disciplinary procedures) and Goals (PPH as a priority). Influences on bundle uptake included: Beliefs about Consequences (perceived benefits of new blood loss measurement tool), Environmental Context and Resources (high cost of drugs and new tools), Memory, Attention and Decision-making (concerns about whether bundle fits current practice), Knowledge (not understanding ‘bundled’ approach), Social Influence (acceptance by women and staff) and Intention (limited acceptance of ‘bundled' approach over existing practice). These influences were consistent across countries. Proposed interventions included: Education, Training, Modelling (core and new skills), Enablement (monitoring uptake), Persuasion (leadership role) and Environmental Restructuring (PPH emergency trolley/kit).ConclusionsA wide range of individual, socio-cultural and environmental barriers and enablers to improving PPH detection and management exist in these settings. We identified a range of interventions that could improve PPH care and the implementation of new care bundles in this context.Trial registrationClinicalTrials.gov: NCT04341662