Documents

READINESS:

The National Partnership for Maternal Safety Hemorrhage Bundle - This patient safety bundle created by The National Partnership for Maternal Safety, outlines what every unit can do to be ready, recognize and prevent, respond to and report on when working toward improving outcomes related to Obstetric hemorrhage.  We encourage you to adapt the bundle to complement the work within your hospital setting. 

 

ACOG Practice Bulletin PP Hemorrhage - This ACOG practice bulletin reviews the etiology, evaluation, and management of postpartum hemorrhage.  The information is designed to aid practitioners in making decisions about appropriate obstetric and gynecologic care as it relates to hemorrhage.

 

CMQCC Obstetric Hemmorhage ToolKit - The California Maternal Quality Care Collaborative (CMQCC) released this document in 2015 aligning with the National Partnership for Maternal Safety Hemorrhage Bundle.  Following the structure of readiness, recognition, response and reporting, CMQCC digs deeper at each level and provides an extensive toolkit packed with a myriad of resources for hospitals to utilize.

CMQCC Obstetric Hemorrhage Hospital Level Implementation Guide - This article provides a framework and step-by-step guidance on how to utilize quality improvement methods to assist healthcare leaders with implementing best practices and tools for obstetric hemorrhage. 

Preparing for Clinical Emergencies in Obstetrics and Gynecology - This ACOG committee opinion paper outlines several vital tools inpatient units should have in place when responding to obstetric emergencies such as hemorrhage.

Massive Transfusion Protocols: The Role of Aggressive Resuscitation Versus Product Ratio in Mortality Reduction - This study looked at the impact of developing a massive transfusion protocol (MTP) and its association with better outcomes and improved mortality rates in the trauma patient population. The most important finding was the development of a protocol to improve communication with the blood bank and decrease the time needed to have components available for transfusion. 

AWHONN postpartum hemorrhage project - This website outlines the postpartum hemorrhage project spearheaded by AWHONN and offers several resources such as articles, videos, and a poster on recognition, readiness and response related to hemorrhage.

Severe Maternal Morbidity: Screening and Review - Identifying severe morbidity is important for preventing injuries that lead to mortality and for highlighting opportunities to avoid repeat injuries. A two-step screen and review process described in this document is intended to efficiently detect severe maternal morbidity in women and to ensure that each case undergoes a review to determine whether there were opportunities for improvement in care.  

American College of Obstetricians and Gynecologists: Safe motherhood initiative - In 2013, ACOG district II kicked off their Safe Motherhood Initiative (SMI).  They set out to develop and implement standard approaches for handling obstetric emergencies associated with maternal mortality and morbidly; obstetric hemorrhage was one of them. Visit this website to access multiple resources related to improving maternal outcomes of those who may experience postpartum hemorrhage.  

Agency for Healthcare Quality and Research. Team Stepps: National Implementation - Focused on improving patient safety within organizations, Team Stepps offers a plethora of information designed to build teamwork, improve communication and integrate successful principles that optimize safe clinical care.  Specifically, as it relates to obstetric hemorrhage, the concepts of briefing and debriefing should be reviewed and integrated into practice.

 

RECOGNITION

An AWHONN Practice Brief on the Clinical Management Guidelines for the use of oxytocin in management of the third stage of labor.  Specific guidance is provided regarding oxytocin use, including dosing and administration.

Postpartum Hemorrhage - This is a chapter from the Advanced Life Support in Obstetrics providing detailed information regarding the causes and methods of preventing postpartum hemorrhage.  The need for early recognition and quick response to postpartum hemorrhage are also discussed, as well as, treatments for hemorrhage.

WHO recommendations for the prevention and treatment of postpartum haemorrhage - This document contains 32 recommendations for prevention and treatment of postpartum hemorrhage; 7 are new recommendations and others have been revised based on new evidence.  All recommendations have been evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology and are presented with the associated GRADE recommendation and the quality of supporting evidence.  The primary source of evidence for all recommendations was Cochrane systematic reviews of randomized controlled trials.  Consideration is given to who would be in attendance at the birth: skilled birth attendant, non-skilled birth attendant or only the delivering mother.  These guidelines were published in 2012 and are scheduled for review in 2017.

 

RESPONSE

Florida Perinatal Collaborative. Obstetric hemorrhage initiative (OHI) tool kit for hospital implementation - This toolkit will provide obstetric care providers, hospital personnel and the collaborating services with the resources to develop their own obstetric hemorrhage policies and protocols.  This document is divided into three sections with recommendations for the providers, the hospital and appendices with supplemental information and resources. This toolkit does utilize portions of the CMQCC toolkit and includes some updated and revised elements as well.

Preparing for Clinical Emergencies in Obstetrics and Gynecology - This ACOG committee opinion paper outlines several vital tools inpatient units should have in place when responding to obstetric emergencies such as hemorrhage.

LEND Support to a Patient or Family Member Impacted by an Adverse Medical Event - Using the acronym L.E.N.D., this quick resource helps clinical staff understand how to be supportive to patient and families when dealing with an adverse medical event such as obstetric hemorrhage. 

AWHONN postpartum hemorrhage project - This website outlines the postpartum hemorrhage project spearheaded by AWHONN and offers several resources such as articles, videos, and a poster on recognition, readiness and response related to hemorrhage.

 

REPORTING

Standardized Severe Maternal Morbidity Review - This article provides guidance in standardizing terminology and definitions for severe maternal morbidity.  It emphasizes the need for standard terminology so that cases of severe maternal morbidity can be reviewed and tenets of quality improvement can be applied.  The case is made that tenets of quality improvement should be applied not only to care processes but also to identification, analysis and review of severe maternal morbidity cases.

Severe Maternal Morbidity: Screening and Review - This article is the current guidance supporting the retired Joint Commission Sentinel Event Alert 44.  The article outlines the importance of identifying and screening cases of severe maternal morbidity.  It highlights that the American College of Obstetricians and Gynecologists and the Society for Maternal and Fetal Medicine have not created or come to consensus on a comprehensive definition of severe maternal morbidity.  The article suggests that in the absence of a comprehensive definition, institutions should utilize existing screening criteria or create a list of their own.  A screening tool with high probability to detect severe maternal morbidity is proposed. 

 

 

 

 

 

 

Pre-work/Work Action Plan 

Required pre-work/work for participation in ASNS - download the guide here

 

Joining the Initiative

Please submit a PQIT Roster for your team

Roster Changes: Please make sure to submit any changes in your team roster.  We would like to be able to provide all team members with the latest information about the initiative and we can only do that with your help.

 

Snapshot

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AIM OBH Snapshot

 

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PQCNC AIM OBH Quality Improvement Assessment 

Download the form here

PQCNC AIM OBH QI Assessment

 

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Initiative Charter/Action Plans/Work Plans 

PQCNC AIM OBH Charter

PQCNC AIM OBH Action Plan

 

Initiative Data: The official start date for Initiative Data Collection is October 01 2017.    

AIM OBH Structure Measures

AIM OBH Structure Measure Dictionary

AIM OBH Structure Measure - How to access form in Delphi

AIM OBH Quarterly Process Measures

AIM OBH Process Measures Dictionary

AIM OBH Monthly Measures

AIM OBH Monthly Mesures Dictionary

Accessing Reports

 

Attention Data Collectors:  

Instructions on how to obtain access to Delphi to submit data.

 

Webinars: 

A multitude of webinars will be available on-demand to assist you in your work

 

Team Meetings: 

Your team will need to schedule at least monthly meetings to review data, make plans for PDSA cycles, and plan for next steps. 

 

Executive Champion:

Please set up times to meet with your Executive Champions to update them on your progress and to ask for their help to meet your goals. PQCNC would suggest you meet with them every other month but no less than every quarter.

Life after Postpartum Hemorrhage - Providing women with anticipatory guidance following a Postpartum Hemorrhage (PPH) is an essential part of discharge preparation. This tool, developed in partnership with PPH survivors, provides women and their families with information about what to expect - and what to symptoms to be aware of - when they go home. The form includes a place for women to indicate which topics they would like more information about and addresses issues related to physical recovery, emotional recovery, and when to seek care. Consider using this tool to supplement existing discharge education information or as a part of the postpartum visit. 

Pateint Discharge Education

Download "Life After Postpartum Hemorrhage'

 

Resources for Postpartum Hemorrhage Survivors (see also individual links below) - Women who have had a Postpartum Hemorrhage (PPH) often have many informational and emotional needs after they leave the hospital. This list of resources was compiled by women who have experienced a hemorrhage following the birth of their child. It includes a selection of websites and online support groups that they have found helpful. Consider sharing this tool with women as part of their discharge education or as part of the postpartum visit.

Patient Resources

Download 'Resources for Postpartum Hemorrhage Survivors'

 

After the ICU: This site was created by a group of doctors, former patients and other healthcare professionals, working together to provide Intensive Care Unit (ICU) patients, their families and other medical professionals with information about the road to recovery after critical illness. Resources are provided that address physical, emotional and cognitive needs following an ICU discharge.

After Trauma: This site is meant to provide a community for survivors of traumatic injury and their families to support and connect with one another. Information and resources are also provided to help survivors and families on the recovery journey.

Amniotic Fluid Embolism Foundation: This site includes resources for family members (caregivers), survivors, and those who have experienced a loss related to Amniotic Fluid Embolism (AFE). Guides and resources help survivors and families from the crucial moments after AFE, through the hours, days and weeks following.

Birth Trauma Association: Resources on this site are meant to support women who have suffered difficult births by offering information, advice and peer support to all women who are finding it hard to cope with their childbirth experience.

Healthtalk.org: This section of healthtalk.org addresses the experience of conditions that threaten women’s lives in pregnancy and childbirth by seeing and hearing people share their personal stories on film. The Teaching Resources area of the site includes key learning messages from interviews with patients who have experienced a near miss.

Hope for Accreta: This site includes photos and stories submitted by Accreta survivors, as well as helpful links and ways to connect with peers both virtually and through local chapters. 

March of Dimes: This section of marchofdimes.org discusses the signs and symptoms, risk factors and treatment of postpartum hemorrhage. Information regarding related conditions is also provided.

Medically Induced Trauma Support Services: The Medically Induced Trauma Support Services (MITSS) site includes a section devoted to patients and families. Resources focus primarily on therapeutic needs and support. In addition to accessing informational support, visitors to the site can read or watch videos of patient and family stories and connect to online support groups.

Postpartum Support International: The site provides links to information about perinatal mood and anxiety disorders, including risk factors, symptoms and treatments. Visitors to the site are able to identify local resources, chat with an expert or join an online support group. Highlights include resources for special groups such as military families, women of color, fathers, and more. 

Preeclampsia Foundation: This site includes multiple resources on preeclampsia and other hypertensive disorders of pregnancy. Visitors can link with health experts for advice and connect with other preeclampsia survivors through the Community Forum or Share Your Story thread. 

Prevention and Treatment of Traumatic Childbirth (PATTCh): Information on this site helps explain the components of traumatic birth and describes the symptoms, risk factors, treatment and prevention of traumatic birth.

Solace for Mothers: The resources available through this site are meant to offer immediate, personal support to mothers and others who are struggling with birth trauma, PTSD after childbirth and anxiety caused by their birthing experiences.

 

Facebook Support Groups

HFA Hysterectomy due to Childbirth Support Group: This is a Facebook Group for women who required a hysterectomy due to childbirth.

Maternal Near-Miss Survivors: This Facebook Group is designed to be a safe place where survivors of a maternal near miss find comfort and offer support to one another. A maternal near miss is defined as an event where a woman nearly dies due to pregnancy or childbirth related complications. 

Postpartum Hemorrhage: This Facebook Group is for people who have experienced a postpartum hemorrhage or excessive blood loss following childbirth. Members include parents, birth workers and health providers.

Postpartum Hemorrhage and Hysterectomy: This is a Facebook Group for women who have experienced a postpartum hemorrhage and hysterectomy. 

Unexpected Project: This Facebook Page is a place for the survivors and loved ones of pregnancy-related death and near-death in the USA to share their stories and raise awareness. Members include women who survived a near-miss, individuals who support near-miss survivors, and loved ones who lost a woman due to complications of pregnancy. 

Download the AIM Snapshot here

AIM OBH Snapshot

 

When you have completed the questions click here to enter your data

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