Improving Maternal Outcomes by Implementing a Maternal Warning Tool for Early Recognition of OB Hemorrhage

Sunday, 17 November 2019

Ashley L. Rainey, MSN, RN
IU Health Bloomington, Bloomington, IN, USA
Elizabeth A. McIntire, MSN, RN, WHNP-BC, C-EFM
St. Vincent Women's Hospital, Indianapolis, IN, USA
Margaret Sharon Harris, MSN, RN, NEA-BC
Maternal Child Health Leadership Academy, Memphis, TN, USA

Introduction / Background: Despite numerous research studies, professional position statements and media coverage on maternal morbidity and mortality, women in the United States continue to be impacted by postpartum hemorrhage. The literature is clear, nationally and locally, postpartum hemorrhage is one of the top three causes that contribute to maternal mortality and morbidity. In the U.S. between 2006-2015 maternal morbidity has increased as much at 45% as defined by 21 conditions and procedures. Of these 21 known conditions, postpartum hemorrhage contributes to 11.5% of the adverse outcomes (Fingar, Hambrick, Heslin, & Brick 2018). In addition, during the same time frame, the amount of blood transfusions rose from 77.9 – 121.1 over 10,000 deliveries, which reflects a 54% increase (Fingar et al., 2018). Key elements of readiness, recognition, response and reporting are essential for interprofessional perinatal teams to improve maternal outcomes. Specifically, tools have been created to serve as early warning signs especially for postpartum hemorrhage such as the Maternal Early Warning Tool (MEWT) which if used properly and consistently offer an opportunity to address postpartum hemorrhage and improve maternal morbidity and mortality (Shields, Wiesner, Klien, & Pelletreau, 2017). This project was completed as a part of the Maternal-Child Health Nurse Leadership Academy (MCHNLA) with support from SIGMA and our program sponsor Johnson & Johnson.

Aim/ Goal/ Purpose: The purpose of this IRB exempt quality improvement project was to implement the Maternal Early Warning tool and measure how the tool impacts nursing early recognition when caring for maternal patients experiencing warning signs of a postpartum hemorrhage.

Methods:

  • Develop a multidisciplinary team
  • Perform a literature review
  • Obtain IRB and Performance Improve Committee approval
  • Conduct baseline and pre and post education assessment related to nurses and physicians
  • Create and Implement online education
  • Create and implement tip sheets for each nurse as a reference
  • Request Maternal Early Warning tool be added to the EMR as a SMARTPHRASE to use as a communication tool
  • Work with unit leader to reinforce education and use of tool
  • Retrospective Chart Analysis looking at the following quality metrics:
    • Time of delivery, cumulative blood loss (QBL), time second hemorrhage medications administered outside of 2nd bag of oxytocin administration (timing / type) if blood products received

Results / Anticipated outcomes: The anticipated outcome is that nurse will recognize a postpartum hemorrhage sooner with using the Maternal Early Warning tool. Earlier recognition will help expedite the management and treatment of a post-partum hemorrhage by administering appropriate medication more quickly and a decrease in the need of blood product administration.

Conclusion: The outcomes of this project should suggest that the use of an Early Warning system facilitates earlier recognition of early warning signs and management which will in return decrease the need of a blood product administration, eventually decrease incidence of postpartum hemorrhage which will ultimately decrease incidence of maternal mortality and morbidity.

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