Date of Publication


Project Team

Jean Pelski, Ph.D., APRN, NNP-BC


Purpose: Despite advances in research and medical technology, the rates of postpartum hemorrhage (PPH) continue to rise. Annually, these preventable events are the cause of one-fourth of maternal deaths worldwide. In order to reduce maternal mortality and morbidity rates, the effective application of evidence-based interventions is required. The purpose of this DNP project was to conduct a gap analysis in community birthing hospitals in Vermont to examine the existing clinical management of PPH.

Methods: Registered nurses at three hospitals were surveyed to assess current policies/protocols pertaining to the management of PPH in five categories: 1) systems level readiness, 2) patient level readiness, 3) recognition and prevention, 4) response, and 5) reporting and systems learning. Quality improvement recommendations targeting PPH management were made based upon the gap analysis.

Results: A total of thirty-seven surveys were completed. Several evidence-based best practice recommendations were inconsistently done, not done, or unknown. Nurses would feel more prepared to manage a postpartum hemorrhage with more simulation drills and mock codes, a walk-through of mass transfusion protocols, easy access to hemorrhage medications, a PPH risk assessment done on all laboring mothers upon admission, and education about identification of PPH.

Conclusions: Areas for improvement were identified across all five categories. A systematic approach to evaluation of current practice protocols and identification of improvement targets with implementation strategies using the California Maternal Quality Care Collaborative (CMQCC) OB Hemorrhage Toolkit V2.0 may enhance clinical management of PPH and maternity outcomes.

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