- Managing PPH requires a comprehensive and interdisciplinary commitment from administrative and medical leaders.
- While there are prescriptive clinical interventions, highlighted in the practice plan, engaging expectant mothers and those supporting them is critical to the holistic improvement of an institution's obstetric safety including PPH.
- Women with risk factors for PPH should be identified and counseled as appropriate for their level of risk and gestational age.
- It is important that leaders ensure availability of resources such as personnel, equipment, blood products and trained personnel.
- Establishing PPH protocols, creation of PPH kits, and appropriate training and simulation drills reduces the risk of PPH.
Practice Plan
The Council on Patient Safety in Women's Health Care developed comprehensive bundles and list of resources that apply to the prevention of harm from PPH and other maternal safety issues. The bundles are a roadmap for hospitals to use in the prevention of harm for these two pregnancy-related conditions.
It is important to remember that approach to management of PPH depends on the etiology in a patient who has had a vaginal delivery or a cesarean section. Treatment of atony depends on the route of delivery. Coagulopathies are managed medically whilst trauma-related PPH is managed surgically.
Technology Plan
Suggested practices and technologies are limited to those proven to show benefit or are the only known technologies with a particular capability. As other options may exist, please send information on any additional technologies, along with appropriate evidence, to
info@patientsafetymovement.org.
- Electronic Health Record (EHR)
- Web-based/EHR predictive algorithms that elicit specific data as but not limited to vital signs (BP, temp, HR, RR and SpO2), lab values, nurses notes and event reports.
- Close monitoring of hemodynamics such as heart rate and blood pressure.
- Ultrasound technology for assessment of retained products, retained placenta or abruption.
Metrics
Topic 1
Severe Maternal Morbidity among Hemorrhage Cases
Outcome Measure Formula
Numerator: Among the denominator, all cases with any non-transfusion SMM code
Denominator: All mothers during their birth admission, excluding extopics and miscarriages, meeting one of the following criteria:
- Presence of an abruption, previa or antepartum hemorrhage diagnosis code
- Presence of transfusion procedure code without a sick cell crisis diagnosis code
- Presence of a postpartum hemorrhage diagnosis code
Metric Recommendations
Direct Impact: All Pregnant Patients
Lives Spared Harm:
\(Lives\ =\ \left(SSM\ Rate_{baseline}-\ SMM\ Rate_{measurement}\ \right)\ x\ Deno\min ator_{baseline}\)
Notes: Since this is a morbidity measure, the lives saved calculation is not applicable.
Data Collection: HDD File (ICD9/ICD10)
Topic 2