Toolkits To Reduce Hypertension in Pregnancy and Obstetric Hemorrhage
AHRQ Safety Program for Perinatal Care, Phase 2
Following the release of AHRQ’s Toolkit for Improving Perinatal Safety, a second bundle of AHRQ tools is available to improve the safety culture of labor and delivery (L&D) units. The second bundle provides resources that align the toolkit’s adaptive care processes with the clinical care processes recommended in the Alliance for Innovation on Maternal Health (AIM) program. The new tools are designed to help L&D units reduce obstetric hemorrhage and severe hypertension in pregnancy, two leading known causes of preventable maternal mortality and severe maternal morbidity in the United States.
- Toolkit Background
- What Are the Hemorrhage and Hypertension Toolkits?
- How To Use the SPPC-II Toolkits
To address the leading known causes of preventable maternal mortality and severe maternal morbidity in the United States, the U.S. Health Resources and Services Administration funded the development of Patient Safety Bundles through the AIM program. Core AIM program Patient Safety Bundles are collections of evidence-based best practices to improve care for obstetrical and perinatal conditions that contribute to maternal mortality and severe maternal morbidity.
In tandem, the Agency for Healthcare Research and Quality (AHRQ) developed the Safety Program for Perinatal Care (SPPC), a collection of tools to improve the patient safety culture of L&D units by improving their communication and teamwork skills. If successful, maternal and neonatal adverse events will decrease. Recognizing the complementary missions of the SPPC and the AIM Patient Safety Bundles, AHRQ funded SPPC-II to create and disseminate resources that align SPPC’s adaptive care processes with the clinical care processes recommended in AIM’s Patient Safety Bundles.
Obstetric hemorrhage and severe hypertension in pregnancy patient safety bundles were selected for integration with adaptive components, given the major contribution of these conditions to maternal mortality and severe maternal morbidity and the advanced development of the AIM patient safety bundles when SPPC-II began.
The SPPC-II project team leveraged content from the original Safety Program for Perinatal Care and AHRQ's evidence-informed TeamSTEPPS program. The goal of this project was to demonstrate the feasibility, sustainability, and scalability of the SPPC-II Teamwork Toolkit. This project was funded by AHRQ and carried out between September 2018 and September 2022.
There are two Safety Program for Perinatal Care, Phase 2 (SPPC-II) Teamwork Toolkits: Hemorrhage and Hypertension. The SPPC-II Toolkits were designed to be an assembly of resources that help clinicians quickly learn specific teamwork behaviors and ways to reliably apply them in their clinical settings.
Training and guidance were developed for two audiences:
Tier 1: Frontline Clinicians
As the heart of patient care and management of maternal mortality and severe maternal morbidity, frontline staff require to-the-point information that briefly but clearly and completely demonstrates how teamwork strategies can be used to recognize and manage obstetric emergencies. Staff members need specific, actionable recommendations, strategies, and tools they can immediately use in their clinical practice.
Tier 2: AIM Team Leads
The SPPC-II Teamwork Toolkit recognizes that individuals responsible for making sure that the AIM Patient Safety Bundles and associated SPPC-II Teamwork Toolkit are successfully implemented in local L&D units require more information than the simple foundations of teamwork. These individuals, termed “AIM Team Leads,” were identified by the State AIM leadership in their State. As leaders who “champion” these initiatives, AIM Team Leads may benefit from more conceptual understanding about teamwork. They may also want or need guidance to effectively implement Tier 1 training emodules and encourage adoption of the teamwork strategies outlined above among their frontline staff. Therefore, the teamwork toolkit modules and materials designed for this audience expand on the foundational teamwork strategies introduced to frontline staff and facilitate implementation planning and rollout.
Each of the two toolkits consists of four primary resources: clinical case scenarios for use by both frontline clinicians and AIM Team Leads, emodules for education of frontline clinicians, PowerPoint slide sets for AIM Team Leads, and a guide for facilitating education sessions with frontline clinicians. L&D units can start with whichever of the two toolkits, hypertension in pregnancy or obstetric hemorrhage, should be prioritized for their unit. Within each of the two topics, then decide whether to focus first on frontline clinicians or AIM team leads.
Clinical Case Scenarios
Two separate clinical case scenarios illustrate the use of 10 teamwork tools and strategies. Each case is illustrated in a comic strip-style presentation that follows the journey of a single pregnant patient who develops either severe hypertension or experiences obstetric hemorrhage. As the patient’s care team recognizes and responds to the clinical demands of each case, the scenario showcases how clinicians may use each teamwork tool and strategy to promote high-quality maternal care. Each case has been compiled into a master scenario that follows the entire patient journey and illustrates the use of each teamwork tool or strategy at least once throughout the scenario. Segments of each case are strategically embedded throughout the tier 1 and tier 2 educational materials described below. Frontline clinicians and AIM Team Leads can review these individually, or they can be presented as part of formal training.
Access the clinical case scenarios.
Tier 1 – Frontline Education
Eight short (8–20 minute) video-based training emodules introduce the frontline audience to the 10 teamwork tools and strategies and showcase their use during a hemorrhage or hypertension case. Each emodule introduces viewers to one to two teamwork strategies and tools. Conceptual explanation of the tools is followed with a segment from the clinical case scenario that demonstrates how the tool or strategy might be employed to assist with managing and coordinating patient care. Frontline staff are also encouraged to participate in facilitation sessions to assist them with embedding the tools and strategies into their routine clinical practice (more information is available in the Facilitator Guide section).
Access the emodules.
Tier 2 – AIM Team Lead Education
Relying on a train-the-trainer model, the goal is to empower AIM Team Leads to disseminate the SPPC-II Teamwork Toolkit to frontline staff (tier 1) in their respective L&D sites. Instructional materials include eight PowerPoint slide sets ideally taught in a live workshop by a master trainer with AHRQ’s TeamSTEPPS Program. Delivery may be either in person or virtual. Instruction covers all the same information provided to tier 1 plus additional foundational information about teamwork principles, how to implement the tier 1 emodules and facilitation sessions in their L&D departments, and time for planning the rollout.
Access the slide sets.
The Facilitator Guide provides guidance with scheduling and conducting facilitation sessions, which are planned, in-person, semistructured, interdisciplinary conversations, and practice opportunities with tier 1 audience members. Facilitation sessions are expected to be a safe opportunity to practice using the teamwork tools and strategies, host discussions about how these tools and strategies might be modified to fit local unit culture, and reinforce the alignment of teamwork tools and strategies with AIM’s 4R framework. They are intended as an opportunity for frontline providers and staff members to have an interactive discussion, offer additional clarity about the teamwork concepts, discuss modes of application of the teamwork tools to the local work environment, and provide bilateral feedback.
Access the Facilitator Guide.