Abstract
Background: Postpartum hemorrhage (PPH) remains a leading cause of preventable maternal morbidity and mortality. Although evidence-based risk assessment and prevention strategies are widely available, consistent implementation of PPH risk-based anticipatory interventions remains challenging. Local Problem: At a Level III maternal tertiary care hospital in Northeast Texas, variation in nursing adherence to PPH risk-based anticipatory interventions was identified despite the presence of standardized risk assessment tools and evidence-based protocols within the electronic health record. Intervention: A multi-component behavioral economics-based nudge intervention consisting of a visual cue and peer-comparison feedback was implemented to improve labor and delivery nurse adherence to PPH risk-based anticipatory interventions. Methods: This pre-post quality improvement project included retrospective chart review of 783 moderate- and high-risk deliveries (355 pre-intervention, 428 post-intervention). The primary outcome was nursing adherence to risk-based anticipatory interventions among moderate- and high-risk patients. Secondary outcomes included PPH rate. Results: Overall nursing adherence decreased from 41.1% pre-intervention to 38.9% post-intervention, a non-significant decline of 2.2 percentage points. The intervention did not improve adherence to PPH risk-based anticipatory interventions. The measured postpartum hemorrhage rate increased slightly from 10.4% (37/355) pre-intervention to 11.2% (48/428) post-intervention; however, this difference was not statistically significant (p = .811). Conclusion: The intervention did not improve overall nursing adherence and did not achieve the project aims. Findings highlight the importance of implementation strategies that support reliable documentation, workflow integration, and sustained adherence to evidence-based PPH prevention practices.
Date of publication
Fall 11-9-2026
Document Type
DNP Scholarly Project
Language
english
Persistent identifier
http://hdl.handle.net/10950/5218
Committee members
Emily Fox, Angie (Mary) McInnis, Jeni Chilton
Degree
Doctor of Nursing Practice
Recommended Citation
Thomas, Stephanie A., "IMPROVING POSTPARTUM HEMORRHAGE RISK-BASED CARE: A QUALITY IMPROVEMENT PROJECT" (2026). DNP Final Reports. Paper 108.
http://hdl.handle.net/10950/5218