Facility Readiness
The first step in improving facility readiness is to form a committee/working group at the hospital/birthing unit. The leadership should consult with all members of the birthing unit so that the initiative is seen as a capacity-building exercise. If the birthing center is a referral center, outreach to the distant units should be included. The committee should meet once a week to maintain focus, keep brief minutes by appointing a secretary, and choose co-chairs (midwife/physician). The goal is to review current practices with a perspective of quality improvement and not be seen as a threat to existing practice or to individual practitioners.
It is important to review your birthing unit data in regards to PPH prevention, diagnosis and treatment. Use a questionnaire for maternal mortality/morbidity in general and PPH in particular.
What essential drugs are available/needed in prevention and treatment? See our Supply Chain page for more details.
What equipment do you have and what is needed?
It is essential that these working groups know the answer to these questions and equip their facilities with the processes needed to assess how prepared they are for PPH treatment.
Essential Equipment To Consider, Delegate Amongst Facility
Prepare a drug box and a PPH tray
Prepare in a metal box the drugs needed and who is charged with replenishing the box. How are drugs obtained by your center and is there a problem of supplies from the government agency in charge with provision of these essential drugs. If so, how can you address this issue at the local/regional /national level? The administrator would be a key person to work on this issue.
Equipment Tray
Health Center Level
IV tray: gloves, large-bore IV, tape to secure IV
PPH tray: Infusion set, blood set, speculum, vaginal retractors, oxygen mask and tank, needle holder and sutures, scissors, Syringes 2,5,20 cc, ring forceps, NASG garment, UBT kit.
Drug Kit Necessities:
- Oxytocin
- Ringers lactate
- Misoprostol
- Methergine or ergotamine
- Tranexamic acid (TXA)
CEmONC Center
Speculum, vaginal retractors, needle holder and sutures, scissors, ring forceps, infusion set, blood sample set, blood transfusion set, oxygen mask and O2 wall supply, UBT kit, NSAG, C-section tray in OR PPH drug kit.
PPH Drug Kit Necessities:
- Oxytocin
- Ringers lactate
- Misoprostol
- Methergine or Ergotamine
- Tranexamic acid (TXA)
- Carboprost
- Carbetocin
Designate person responsible daily to verify the trays on ward and OR.
Verify Electricity Throughout Facility
Verify electricity availability and plan for alternate lighting. Verify if safe clean hot and cold running water, if not boiled water to be available or sealed water supply.
Clearly outline how to call for help when needed. Review how members access help when PPH occurs. Is it a code, a bell, a cellphone, and will a shout for help bring all help available to the bedside?
PPH Guideline At The Ready
Make sure that there is an appropriate national guideline in the facility, and that this is easily available and often referred to. It should if possible build on FIGO/WHO PPH guidelines.
PPH Poster In Delivery/Birthing Room
In the delivery room/birthing unit make sure that a simple poster is easily visible, highlighting the key 6-7 seven interventions necessary.
PPH Simulation And Training
Establish PPH training using simulation exercise for all members. You may want to invite a regional/national expert to come to your unit to organize a train the trainer workshop. The unit should have continuous training sessions at regular intervals to refresh the health workers' response to PPH treatment.
Emergency numbers and referral pathways
Make sure that the facility/birthing unit has clear communications with peripheral and central facilities in the district. Phone numbers, with back up numbers, including to emergency transport. Agreed rules for hotline and referrals should be on the same sheet of paper, easily available.
