Development of an Algorithm for Postpartum Hemorrhage Resuscitation

Abstract

The United States has the highest rates of maternal mortality and morbidity in the developed world with postpartum hemorrhage being a leading cause. This Doctor of Nursing Practice (DNP) project was set out to identify evidence-based research regarding the medical care of mother’s experiencing a postpartum hemorrhage and to develop a resuscitation algorithm for anesthesia providers at a facility lacking a concrete process. The first phase of the project involved the development of an algorithm using a literature review of current evidence and recommendations provided by the American College of Obstetricians and Gynecologists current guideline for a level 3 trauma center in Mesa, Arizona. During the second phase, the participants graded the algorithm and agreed that the development algorithm was high quality and could move towards dissemination. The principle investigator disseminated the results and an educational presentation about PPH to the anesthesia providers at their monthly meeting. The Kurt Lewin Change Theory guided the implementation and integration of the algorithm. The material was well received and feedback on the presentation and developed algorithm was requested. There were no further suggestions made by the team and it was ensured that medications suggested in the algorithm were available in the formulary. The chief of the department plans to integrate the algorithm into their OB anesthesia manual and several copies of the algorithm were posted throughout on the unit for quick and convenient access during a crisis response. It was suggested that ongoing education and evaluation of the current algorithm be introduced for continued success. Translation of research into clinical practice continues to be a challenge, however, the presented algorithm serves to bridge the gap between research and clinical practice with the intent to improve patient outcomes in this unique population.