PREVENTION AND MANAGEMENT OF PRIMARY POSTPARTUM HEMORRHAGE IN A TEACHING HOSPITAL: A BEST PRACTICE IMPLEMENTATION PROJECT

Background: Official data from Brazil shows a maternal mortality rate of around 52 to 75 deaths per 100,000 live births, 8% caused by hemorrhage. Early diagnosis is promoted through standardization and formal documentation of the first signs of hemorrhage.
Objectives: The aim of this project was to develop and implement strategies to promote standardization and formal documentation of increased bleeding within the first 24 hours after birth, in compliance with best practice.
Methods: This implementation project used the Joanna Briggs Institute Practical Application of Clinical Evidence System software, a baseline audit was conducted including a sample size of 108 patients and 67 nursing staff. Reflecting on the results of the baseline audit, strategies to address non-compliance were designed and implemented. A follow-up audit was conducted including a sample size of 110 patients and 68 nursing staff, using the same audit criteria.
Results: The base-line audit showed poor compliance with evidence-based best practice in every criterion. The standardization of identification and documentation was well received by the nursing staff, promoting early diagnosis of increased bleeding within the 24 hours after birth and providing support for further medical treatment. There were significant improvements in every best practice criterion in the follow-up audit.
Conclusions: The nursing staff was engaged with postpartum hemorrhage and it was possible to implement changes in the practice of the professionals, reducing the absence of records.