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Women's Health | Postpartum Hemorrhage
For years the Military Health System has provided new mothers with high-quality care that consistently tops the civilian health care sector.
Now, the MHS is working to further improve that safety record by standardizing prevention and treatment for one of the biggest health risks for new mothers: post-partum hemorrhaging.
A rare, but serious condition that women can experience up to 12 weeks after childbirth, post-partum hemorrhaging, known as PPH, is the leading cause of preventable maternal deaths worldwide, said Air Force Col. Sheelah Walker, interim lead of the Defense Health Agency's Women's Health Clinical Management Team (WHCMT).
"While prevention of PPH is not always possible, prompt assessment, recognition, and communication of maternal hemorrhage risk, as well as timely interventions according to risk level, can reduce maternal morbidity and mortality and improve outcomes," she said.
The ongoing focus on maternal health care in the MHS has already pushed the rates of maternal and infant mortality down much lower than the United States overall, according to a 2019 report from the Office of the Secretary of Defense. The MHS rates in recent years were at 7.4 deaths per 100,000 live births, significantly lower than the 11.3 reported at non-MHS facilities nationally.
To build on that performance, the MHS has put in place new treatment protocols following national guidelines for staff to provide standardized care.
In January 2021, the DHA issued a procedural instruction (PI), establishing a set of standardized components to assist with postpartum hemorrhage clinical processes and resources that are aimed at improving maternal care.
Since then, the WHCMT has led a campaign to improve the implementation of risk assessment and access to resources to speed up the treatment and prevention of maternal complications during a mother's entire journey of obstetrical care – meaning before, during, and after the birth of her baby.
The campaign sought to implement the new guidelines and encourage staff compliance at 12 military hospitals in two initial waves. The process to decrease complications from postpartum hemorrhage is a world-wide initiative. MHS has been introducing the concepts and standards for the past two years.
The teams used adopted measures to track the changes in clinical practice and established a baseline for outcome metrics – such as incidence of PPH, blood transfusions, intensive care unit admission, and hysterectomy associated with PPH. The goal is to track improvements on the short and long-term impact on maternal outcomes, Walker said.
The effort has been a success. "As of September 2021, the post-partum hemorrhaging bundle campaign achieved 97% compliance," said Walker. This means they achieved their goal in less than a year since the PI was issued.
"Military hospitals overcame both local and MHS-wide challenges such as funding and procuring supplies, gaining staff buy-in, and aligning with electronic health record platform updates to be in compliance with PPH documentation requirements," she said.
The teams at the military hospitals now have access to a robust library of resources, support, and training materials as well as an established community of peers to engage and share leading practices, said Walker.
"The dedication and tireless work of the PPH champions at each military hospital enabled the establishment of PPH guidelines, hospital-specific policies and procedures, and staff training," said Walker. "Establishing the instruction and implementing the post-partum hemorrhaging bundle campaign sets the standard for providing standard, best-care practices for mothers."
The effort also aligns with guidance from the Alliance for Innovation on Maternal Health for requiring system-level readiness, recognition, response, and reporting, which is expected to support the reduction of maternal morbidity and mortality and improve patient outcomes.
"As all military hospitals adopt, adapt, and fully implement the DHA-PI, patients and staff will experience improvements in readiness to identify and treat hemorrhage; standardize supplies, equipment, and processes; decrease variation when staff transfer between military hospitals; automate outcome metrics for military hospitals to evaluate their care, and enhance the quality of care for all patients and their families," Walker said.
The campaign's work directly supports the local military hospitals by giving them the resources and tools they need to provide patients and staff with information and training about how to respond to PPH.
"Beginning in January 2022, all military hospitals that provide inpatient obstetric care are required to report compliance in accordance with PI guidelines on a quarterly basis, via an online data collection tool," said Walker.