Horton, LaShawn

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Purpose: To evaluate the effectiveness of a multidisciplinary moderate fidelity simulated postpartum hemorrhage (PPH) educational intervention on accurate and timely adherence to a standard PPH protocol during simulated PPH events.

Methods: The study design was a quasi-experimental one group pretest- posttest time series utilizing a convenience sample of multidisciplinary nurses, nursing assistants, laboratory, and physician staff working at one rural hospital with an annual birthrate less than 100. The intervention was an educational in situ PPH moderate fidelity scenario with pre-brief and debrief. Change in performance was evaluated using unannounced PPH simulation drills at three one-month intervals following the intervention. Performance accuracy and timeliness were measured using a standard facility PPH protocol and time metrics record (time to obtain PPH cart after diagnosis, time to administer second uterotonic, time to insert balloon tamponade). The institutional review board at Southern Adventist University granted approval.

Results: 65 multidisciplinary subjects participated. Performance accuracy was significantly better following the intervention; mean baseline score was 83.82 (SD = 17.367) while mean three-month post score was 100.0 (SD = .000). There were no statistically significant reductions in the mean times of the metrics: PPH cart procurement mean time decreased by 13.93 seconds [F (3, 25) = 0.308, p = .820]; Time to second uterotonic mean time increased by 19.00 seconds [F (3,25) = 1.68, p = .196]; Balloon tamponade mean insertion time increased by 26.51 seconds [F (3,25) = 1.93, p = .150]

Conclusion: The intervention was associated with improved PPH management accuracy but not timeliness.

Keywords: postpartum hemorrhage management, multidisciplinary, simulation