Graduation Date

Summer 8-31-2025

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

Catherine Johnson

Committee Member

Rebecca Vrescak

Committee Member

Margo Kandrack

Keywords

obstetric hemorrhage, risk assessment, interdisciplinary communication, maternal morbidity, maternal mortality

Abstract

Obstetric hemorrhage (OBH) remains a leading cause of preventable maternal morbidity and mortality in the United States. Accurate risk identification is critical for initiating timely interventions; however, current risk assessment practices vary significantly. This quality improvement (QI) project aimed to implement the California Maternal Quality Care Collaborative (CMQCC) OBH Risk Assessment Tool on the labor and delivery (L&D) unit of a community-based hospital to standardize risk stratification and improve interdisciplinary communication. Guided by the Johns Hopkins Nursing Evidence-Based Practice model, the project involved a gap analysis, staff education, and the introduction of a paper-based CMQCC tool formatted for visibility and ease of use. Pre- and post-implementation surveys, direct observations, and documentation audits assessed tool adoption, communication patterns, and alignment with electronic health record (EHR) risk assessments. A total of 61 CMQCC assessments were collected; 28 were fully completed. Among 22 cases with both CMQCC and EHR data, 73% demonstrated concordance, while 27% showed discrepancies, most often with the EHR under-recognizing risk. Post-implementation surveys indicated improved documentation, more transparent communication, and greater awareness among providers. However, inconsistent training attendance and a brief evaluation period limited the comprehensive assessment of long-term outcomes. Implementing the CMQCC OBH Risk Assessment Tool improved standardization of risk identification and interdisciplinary communication. Integrating the tool into the EHR and expanding training efforts are recommended to sustain improvements and reduce OBH-related morbidity.

Language

English

Download
COinS