Stop the Bleeding: A Postpartum Hemorrhage Protocol
Article first published online: 14 JUN 2012
© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2012 Convention Proceedings
Volume 41, Issue s1, page S11, June 2012
How to Cite
Dudas, L. and Pedaline, S. H. (2012), Stop the Bleeding: A Postpartum Hemorrhage Protocol. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41: S11. doi: 10.1111/j.1552-6909.2012.01359_8.x
- Issue published online: 14 JUN 2012
- Article first published online: 14 JUN 2012
- postpartum hemorrhage;
- postpartum hemorrhage risk factors;
- postpartum hemorrhage interventions
Purpose for the Program
A woman dies somewhere in the world every 4 minutes from postpartum hemorrhage. Severe bleeding is the number one cause of maternal death and it is estimated that 75% of those deaths are preventable. Statistics have shown a significant increase in the national incidence of postpartum hemorrhage over the past 5 years. A multidisciplinary task force was established to review the literature and develop and implement a protocol to decrease the incidence of postpartum hemorrhage in a large, university hospital birth center. The key focus of the protocol is recognition of risk factors, anticipation, and mobilization of personnel.
Postpartum hemorrhage by traditional definition is a blood loss greater than 500 ml following a vaginal birth or greater than 1,000 ml following a cesarean birth. A protocol was developed that defines postpartum hemorrhage as any blood loss that causes a life-threatening physiological change (e.g., change in vital signs or loss of consciousness). The protocol identifies prenatal assessment and planning, admission hemorrhage risk factor evaluation, ongoing risk assessment, and four stages of hemorrhage (based on estimated blood loss, vital sign stability, need for blood products, and surgical intervention).
Implementation, Outcomes, and Evaluation
A multidisciplinary team consisting of nursing, physicians, pharmacy, anesthesia, quality, and blood bank/lab personnel was established to propose a protocol to improve the assessment and management of postpartum hemorrhage. Hospital staff were educated so that protocol implementation would be standardized no matter where the patient was located in the hospital. The overall outcome was to decrease the incidence of the rate of postpartum hemorrhage.
To implement the protocol, the following were created: a postpartum hemorrhage kit in the automated medication cabinets, laminated algorithms for patient care units in table form and flow chart form, computerized physician order set for postpartum hemorrhage, photograph examples for the estimation of blood loss, and four separate staff education presentations on patient care units were posted and sent via e-mail.
Since initiation of the project, a decrease in the incidence of the rate of postpartum hemorrhage, within 24 hours of delivery, has been demonstrated through cumulative statistics based on diagnosis coding. Statistics reveal a 5% rate of postpartum hemorrhage since the implementation of the project (down from 6% in June 2009).
Implications for Nursing Practice
The implementation of the protocol has helped staff to recognize the importance of assessing each patient for the risk of postpartum hemorrhage and the need to maintain current blood work. In addition, the protocol has given all members of the health care team tools for recognizing the need for and implementing timely and well-coordinated interventions when faced with this life-threatening and increasingly common complication.