Lean Management Principles to the Creation of Postpartum Hemorrhage Care Bundles

Postpartum hemorrhage (PPH) is the number one cause of pregnancy-related death in the US. The Maternity local improvement team (LIT), co-led by an Obstetrician and Board Certified Clinical Nurse Specialist found that each month the maternity unit averages 40 PPHs with 1-2 resulting in an emergency. Over a 6-month period, the LIT decreased response time for emergencies significantly. Supply retrieval time decreased by 99.9%, MD response time decreased by 81%, and Family Centered Care increased by 100%. They recently turned their attention to prevention. Given the lack of literature on preventing PPH in postpartum units, the team developed a PPH prevention bundle-a small set of evidence-based interventions enhancing teamwork and communication to improve patient outcomes. Dr. Crowe as the national lead for benchmarking obstetrical adverse events in the Solutions for Patient Safety collaborative will track the success of the PPH bundle, which could become the first national standard in prevention of PPH requiring a blood transfusion. The team targeted 100% compliance to bundle elements, with an ultimate goal of decreasing need for transfusion. Many problems have been encountered along the way, such as RN handoffs from Labor and Delivery as well as having appropriate staff to help new mothers to the bathroom for the first time, but the team has worked through them one-by-one. Through simulation training over a 6-month period, 100 RNs, MDs, and family representatives simulated the bundle approach. The PPH Prevention Bundle could become the first national standard in prevention of PPHs on a postpartum unit.