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William Beaumont Army Medical Center medical personnel prepare for treatment of a simulated postpartum hemorrhage using WBAMC’s new simulation system which provides cutting-edge scenarios for training to medical staff. The new simulation system at the Fort Bliss facility aims to increase communication and improve interdisciplinary and clinical performance of staff when treating obstetric emergencies.

FALLS CHURCH, Va. — The Defense Health Agency’s Women and Infant Clinical Community has recently implemented standardized practices to improve maternal outcomes in all its military medical treatment facilities around the world.

The new DHA-Procedural Instruction 6025.35, Guidance for Implementation of the Postpartum Hemorrhage Bundle, provides instruction for implementation of the postpartum hemorrhage bundle at all MTFs providing obstetrical care.

Prior to issuing the DHA-PI in January, the Military Health System had many different methodologies, but not an enterprise standard for the process to evaluate risk assessment and resources to promptly treat PPH to prevent maternal complications, said U.S. Public Health Service Capt. Anne McMillan, PPH Bundle Campaign co-lead and interim lead for the DHA Women’s Health Clinical Management Team.

Considering PPH accounted for 10.7% of all maternal deaths in the United States between 2014 and 2017, according to the Center for Disease Control - Prevention’s Pregnant Mortality Surveillance System, the effort is an important step in standardizing clinical practices and processes in obstetric care to reduce maternal morbidity and mortality across the MHS.

“The PPH campaign implements leading practices drawn from research and national and international organizations,” McMillan said. “It provides a universal set of recommendations to standardize the clinical processes and resources that have been shown to help prevent and treat PPH.”

The Navy Bureau of Medicine and Surgery adapted the hemorrhage safety bundle and implemented it across its medical facilities in 2016, according to McMillan. Building upon the lessons learned between 2017 and 2019, the Defense Health Agency conducted a PPH bundle pilot program at five military medical treatment facilities. This pilot program further defines the standardized processes and develop a DHA PPH procedural instruction that would provide implementation guidance across the MHS, focusing on specific equipment, resources and procedures required to enhance a system-level response.

As part of the bundle, each MTF must have a six-drawer purple cart with supplies, equipment and medications specific to standard PPH treatment, allowing for immediate access to resources, explained McMillan. Additionally, each MTF must provide consistent assessments of a mother’s risk factors throughout the course of perinatal care, before and after birth.

“Standardization of the review of a patient’s risk factors or medical conditions is built into the medical record, with corresponding actions to support moderate and high-risk mothers,” she said.

“The bundle components are designed to address specific steps to identify, prevent and/or respond to a PPH event, and efforts are underway to update training, supplies, equipment and resources and develop closer collaborations to decrease adverse outcomes for mothers and their families,” McMillan explained. “Well prepared health care teams and informed patients comprise the best teams to prevent complications and improve outcomes for mothers and their families.”

Additionally, the PPH bundle implementation campaign is one of DHA’s strategic priorities for fiscal 2021. WICC started the implementation project in October 2020 in 12 MTFs with inpatient obstetrical units, focusing on readiness, recognition/prevention, response and reporting.

“Implementation of the PPH bundle is one of many clinical strategies being implemented to further support military readiness and quality of care for all beneficiaries and their families,” McMillan added.