Structure, Process, and Outcome Data of AWHONN's Postpartum Hemorrhage Quality Improvement Project

To describe the structures and processes implemented during the Association of Women's Health, Obstetric, and Neonatal Nurses Postpartum Hemorrhage (AWHONN PPH) Project.

An 18-month, multiregion, multihospital quality improvement project.

Fifty-eight hospitals located in Washington, DC; Georgia; and New Jersey.

Volunteer registered nurse hospital leaders implemented the AWHONN PPH bundle, which consisted of structure and process improvements.

The process and effectiveness of the implementation of the interventions were measured and compared between baseline and after implementation.

All structures and processes showed improvement but were not fully implemented at all sites. Registered nurse participation in drills increased from 0% to 92%, quantification of blood loss increased from 5% to 45%, hemorrhage risk assessment increased from 10% to 70%, prebirth risk assessment increased from 2% to 52%, postbirth risk assessment increased from 2% to 57%, and debriefing increased from 1% to 13%. No statistically significant differences were found in the pre- and postimplementation outcomes measured (maternal deaths, blood products transfused, women with massive transfusions, peripartum hysterectomies during the birth admission, and ICU admissions for women who gave birth and/or had a postpartum hemorrhage). Participants' self-assessments of their monthly implementation efforts (leader intensity) were not correlated with implementation fidelity (the degree to which the intervention was provided as proposed).

None of the 58 hospitals were able to implement all of the structure and process changes before the end of the 18-month implementation phase. This suggests that an 18-month implementation phase may be too short.