Identify methods to create, implement, and evaluate a nurse driven, evidence-based project to improve postpartum hemorrhage outcomes

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2 Identify methods to create, implement, and evaluate a nurse driven, evidence-based project to improve postpartum hemorrhage outcomes Describe the prevalence of post-partum hemorrhage and the mortality associated with post-partum hemorrhage Demonstrate the success of the performance improvement project through empirical data

3 Three PP hemorrhage events in October 2013 were the catalyst for a performance improvement project Charge RNs discussed need to improve response process and response time to PPH events PPH emergency supplies were kept in different locations on our two floors, and could get moved by well meaning staff Supply par levels were hard to consistently maintain Varying degrees of staff and physician knowledge related to type, location and use of supplies and medications during PPH events

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5 Postpartum Hemorrhage (PPH) affects 1-3% of pregnancies in the first 24 hours after birth PPH is a leading cause of pregnancy-related mortality in developed countries Deaths due to PPH have declined but serious morbidities have remained constant and include massive transfusions, secondary surgical procedures, ICU admissions and fertility loss

6 compared to : 75% increase in severe maternal morbidity 184% increase in the number of women who received a blood transfusion during a hospital birth admission (AWHONN Postpartum Hemorrhage Project)

7 I know! Let s do a Performance Improvement Project based on our most immediate need!

8 Developed an Inter-professional Team Identified Action Steps Assigned responsibilities Established a timeline for the project and each task Considered resources (available and needed) Identified potential barriers Developed a communication plan with the team and all units Set Milestone Measures to stay on track

9 Legitimizes the project across disciplines Assures a specific focus and agreement on goals Helps troubleshoot problems and identify next steps Everyone is accountable and shares in the outcomes

10 The goal of the plan was to make emergency post-partum hemorrhage (PPH) supplies readily available 100% of the time and to decrease the volume of blood products administered due to PPH. Emergency supplies were standardized and made readily available to responders by creating the PPH Carts. These are similar, in style, to Code Blue Crash Carts. The original action plan went through several transformations and some surprises were discovered along the way.

11 Difficult to arrive at a consensus on necessary items for post-partum hemorrhage carts. Wow! We had enough supplies to fill three carts, per floor! We had to agree on what to pare down. Again, front-line RNs took the lead. Our pharmacy required separating meds into refrigerated and unrefrigerated. Carts would require the same compliance attention as the code blue crash carts. Go Live was pushed back from January 1 st to April 1 st Initial issues with hardwiring the cart check and re-stock process

12 Education was provided on all the PPH Cart equipment. The PPH Cart was presented in Staff Meetings. Education included: Scavenger Hunt in the cart Videos and quizzes Mock PPH drill scenarios began Go Live was scheduled after 95% of nursing staff completed education Ongoing communications

13 The results, to date, have been positive: The average number of blood units dropped from units of blood given per birth pre-implementation to units of blood given per birth post-implementation. Of note, one of the post-implementation patients received 33 units of blood due to a uterine and iliac blood vessel tear. This caused an outlier in the post-intervention data. This cart, in large part, played a vital role in preventing her death. The current analysis of the data demonstrates that this project is successful. Without this outlier the number of blood units drops to units of blood given per birth.

14 0.35 Units of blood given per birth due to Post Partum Hemorrhage Implementation of the PPH Cart Units of blood given per birth due to PPH with outlier Units of blood given per birth due to PPH without outlier

15 Continued evaluation of impact on response and hemorrhage events requiring transfusion and average units of blood utilized per patient Develop and implement an OB massive transfusion protocol using the CMQCC guidelines Continue and enhance mock scenario drills with our team, using the Noelle simulation doll Development of an OB STAT team

16 Mortality and Morbidity from PPH is preventable!