Postpartum hemorrhage is the main cause of maternal mortality worldwide, and in the United States it causes nearly 11% of pregnancy-related deaths. Early recognition and prompt treatment can stem blood loss and reduce maternal morbidity and mortality. Researchers at Johns Hopkins University came up with the idea of a crash cart loaded with supplies to treat postpartum hemorrhage to cut response time, then set out to systematically compare its utility to customary practice.
The research team used Lean Six Sigma tools to measure response times under existing protocols compared with times achieved using the cart. To identify factors affecting response time, they ran simulations on the labor and delivery unit, working with a predetermined list of supplies commonly used to treat postpartum hemorrhage. In the simulation, a team leader at the bedside called for each tool or medication and, as in an actual postpartum hemorrhage emergency, a nurse went to retrieve the item. The researchers used a stopwatch to clock the time it took to bring supplies to the bedside.
Seven baseline simulations were run with nurses of varying experience. On average, it took 11 minutes and five seconds to gather the needed supplies-a potentially dangerous delay in response to a bleeding emergency.
The researchers hypothesized that a postpartum hemorrhage "crash cart" stocked with all necessary nondrug supplies could cut response time by 50%. To test this, they purchased a five-drawer mobile cart and stocked it with the standard supplies. Another simulation was run as above, and response time dropped to four minutes and zero seconds. But drugs were not included among the supplies and gathering them involved three trips to an automated drug dispensing machine (Pyxis).
The researchers decided to revise the intervention to include a "drug box" containing four uterotonic drugs to be stored together in the Pyxis. Eight additional simulations were run, with postpartum hemorrhage response now requiring only cart and medication box retrieval. Response time dropped to two minutes and 14 seconds-a 79.8% reduction from baseline. The team is in the process of gathering clinical data to compare patient outcomes in the pre- and postintervention periods.
Susan E. Will, patient safety nurse in the Department of Gynecology and Obstetrics at Johns Hopkins and a member of the research team, told AJN that nurse feedback on the new protocol has been positive, and as in cardiac emergencies, staff will sometimes place the cart ahead of time in the room of a high-risk postpartum patient. Having the crash cart "makes a world of difference," said Will.-Betsy Todd, MPH, RN