Developing post-partum haemorrhage emergency kits using participatory methods
This study aims to develop a comprehensive description of post-partum haemorrhage kit design and use in UK maternity units. It will then seek to build consensus around best practice and how to tailor kit design depending on the setting.
Post-partum haemorrhage (PPH) is an obstetric emergency that causes around 100,000 maternal deaths worldwide, mostly in low- and middle-income countries. The incidence of PPH is also rising in high-income countries, where it leads to complications in more than one in 100 births. In healthcare settings, most PPH-related deaths can be avoided through a series of swiftly taken, simultaneous actions.
Treatment requires prompt initiation of several actions including uterine massage, intravenous fluid resuscitation and administration of medication. Treatment delay is highly consequential for outcome: deaths from PPH peak at 2–3 hours after childbirth. It is therefore important that healthcare professionals can mobilise quickly, use evidence-based practice and have ready access to the appropriate supplies.
The use of PPH emergency kits is associated with improved outcomes and significant reductions in mortality. In the UK, PPH kit design and contents are generally agreed locally and tend to vary from one maternity unit to another. For example, some kits include medicines and treatment algorithms to guide the clinical response, whereas others do not.
PPH kits need to fit in with existing systems and practices, and allow for variability in local context, such as the size or type of maternity unit. Standardisation is therefore challenging, and improvement efforts must be based on shared best practice and a sound analysis of work systems and the context in which kits are deployed.
The protocol for a mixed methods study into characterising and describing PPH emergency kits in context was published in 2020. This study will explore the contextual influences on practice relating to PPH kits and describe the range of kits in use in UK maternity units. Using participatory methods, we will seek contributions from a wide range of people from across the UK, including midwives, maternity assistants, obstetricians and those involved in supply and procurement.
The study will follow a user-centred design process to ensure that an understanding of users’ tasks, requirements and professional experience informs the resulting recommendations. There will be a series of interrelated phases of work.
During the first phase, we will visit a select number of UK maternity units and analyse how PPH kits are used in practice, using an established human factors and ergonomics (HFE) framework. Our aim will be to see how adaptations and ‘workarounds’ work across a range of scenarios. In addition, UK maternity unit staff will be invited to submit photographs of the contents and design of their PPH kits through the Thiscovery.org platform. This will enable us to audit the types and contents of PPH emergency kits in the UK for the first time, and give us detailed information about the size, content and layout of kits that would not be obvious from a written list of items.
The second phase will involve working with maternity unit staff to identify the best way to organise and pack PPH kit items, depending on the context they are working in. In addition, we will work with stakeholders to understand what project outputs would best suit the needs of maternity services.
The phase will be to work with stakeholders to co-produce accessible and actionable resources which outline core PPH kit design and contents, helping those working in a range of maternity settings to work to best practice, yet also enabling units to tailor kits to their setting.
Funding and ethics
This study is funded by the Health Foundation’s grant to The Healthcare Improvement Studies Institute (THIS Institute). It is independently led by THIS Institute and clinicians from the PROMPT Maternity Foundation. This study received ethics approval from the Health Research Authority (HRA).