Graduation Date

Fall 8-21-2026

Submission Type

Dissertation/Thesis

Degree Name

Doctor of Nurse Anesthesia Practice

Department

Doctor of Nurse Anesthesia Practice (DNAP) Program

School

School of Nursing

Faculty Mentor

Rebecca Vrescak

Keywords

postpartum hemorrhage, maternal hemorrhage, obstetric anesthesia, CMQCC, quantitative blood loss, quality improvement, protocol adherence, tranexamic acid

Abstract

Postpartum hemorrhage is a leading cause of preventable maternal morbidity and mortality and requires rapid, coordinated response among obstetric, anesthesia, nursing, and blood-bank teams. This quality improvement project implemented and evaluated a California Maternal Quality Care Collaborative (CMQCC)-based Code OB maternal hemorrhage intervention at a western Pennsylvania hospital. The project aimed to improve anesthesia provider knowledge, confidence, and readiness to recognize, stage, and respond to maternal hemorrhage using standardized guidance, quantitative blood loss (QBL) measurement, and point-of-care cognitive support. Guided by the Institute for Healthcare Improvement Model for Improvement and a Plan-Do-Study-Act cycle, the intervention included a focused educational presentation and badge buddy reference cards. Evaluation included anonymous pre- and post-intervention provider surveys and aggregate electronic health record data from 10 pre-implementation and 10 post-implementation cesarean deliveries. Provider knowledge and confidence improved descriptively. Findings suggest favorable preliminary trends in provider preparedness, hemorrhage recognition, and selected clinical practice measures. Results should be interpreted cautiously because of small samples, anonymous nonpaired surveys, cesarean-only clinical data, lack of patient-level risk adjustment, and overlapping implementation and measurement periods. Future PDSA cycles should strengthen Epic data capture, include vaginal deliveries, measure direct protocol adherence, and evaluate sustainability across the interdisciplinary maternal hemorrhage response system.

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