FPQC OHI 2.0 Key Resources

• OHI 2.0 Toolkit Document
• OHI 2.0 Key Driver Diagram
• OHI 2.0 Quick Start Guide
• 30-60-90 Day Plan Template
• 30-60-90 Day Plan Example

FPQC OHI 2.0 Data Resources

• Patient-Level Data Collection Form 
• Hospital-Level Data Collection Form
• OHI Baseline Data Form
• Measurement Grid
• OHI 2.0 Data Collection Instructions and Tools

Newest resources since August 2025

Driver 1: Readiness

• Strategies for Improving Postpartum Hemorrhage Outcomes (American Heart Association and EPIC)
• FPQC Post-Birth Bleeding Patient-Facing Flyer – This flyer can be used to help educate patients with hemorrhage risk factors on what to expect if they experience bleeding during or after birth
• TJC HR 11.03.01 EP 2 and 4: Applicable staff are trained annually on the protocols and provisions implemented for emergency services readiness and the hospital is able to demonstrate staff knowledge on the topics implemented

Driver 3: Response

• OPQIC Patient Summary Form
• H Magnet from South Miami Hospital: Placed outside the door to alert others that the patient is at high risk for hemorrhage
• FPQC Patient Brief Tools on Obstetric Hemorrhage
  • OB Hemorrhage Patient Brief Guidelines and Checklist for Providers
  • OB Hemorrhage Provider and Patient Brief Sample Script
  • EPIC Guidelines - Briefing & Discharge Paperwork
• FPQC Post-Birth Bleeding Patient-Facing Flyer – This flyer can be used to help educate patients with hemorrhage risk factors on what to expect if they experience bleeding during or after birth

• Updated FPQC PACC Patient-Facing Copy of the Post-Birth Health Check – Symptoms to look out for and postpartum support help lines
• PQCNC Life After Postpartum Hemorrhage - Resource for patients to learn what to expect during recovery after a hemorrhage and identify topics they would like more information on
• FPQC Patient Family Advisory Council Implementation Checklist
• TJC LD 13.01.01 EP 20-22: The hospital has adequate provisionsand protocols consistent with nationally recognized and evidence-based guidelines to meet the emergency needs of patients.

Obstetrical Transfer Resources

• PC 14.01.01 EP 15: The hospital has written policies and procedures for transferring patients to the appropriate level of care as needed to meet the needs of the patient. The hospital also provides annual training to relevant staff regarding the hospital policies and procedures for transferring patients.

General Resources

• ACOG Committee Opinion 590: Preparing for Clinical Emergencies in Obstetrics and Gynecology
• ACOG Safe Motherhood Initiative: Obstetric Hemorrhage
• AIM Obstetric Hemorrhage Patient Safety Bundle
• AWHONN Practice Brief Number 13: Quantification of Blood Loss
• The Joint Commission R3 Report: Provision of Care, Treatment, and Services standards for maternal safety
• Strategies for Improving Postpartum Hemorrhage Outcomes (American Heart Association and EPIC)

1a: Develop standardized, facility-wide, stage-based OB hemorrhage emergency management plans

Evidence/Rationale

• ACOG Committee Opinion 664: Refusal of Medically Recommended Treatment During Pregnancy
• ACOG Practice Bulletin 183: Postpartum Hemorrhage
• ACOG Practice Bulletin 211: Critical Care in Pregnancy
• Kawakita et al. 2019 Evaluation of Risk Assessment Tools for Severe Postpartum Hemorrhage in Women Undergoing Cesarean Delivery

Toolkit Resources

• AWHONN Risk Assessment Tool  – You must provide your name and email address to download these free resources
• AWHONN PPH Stages Algorithm
• Revised ACOG Obstetric Hemorrhage Checklist – coming soon
• FPQC Post-Birth Bleeding Patient-Facing Flyer – This flyer can be used to help educate patients with hemorrhage risk factors on what to expect if they experience bleeding during or after birth
• ACOG Massive Transfusion Protocol
• ACOG Declination of Blood Products – Guidance document
• ACOG Obstetric Care Consensus 9: Levels of Maternal Care
• SMFM OB Emergency Transfer Checklist – Maternal transport briefing form and checklist to assist hospitals with emergency transfers
• Hemorrhage Cart Example – Winnie Palmer Hospital
• OB Emergency Transfer Resources – coming soon

Additional Resources

• AWHONN POST-BIRTH Warning Signs Education Program – Structured education program for clinicians with cost involved
• CMQCC Appendix C Obstetric Hemorrhage Care Guidelines Table – Staging algorithm table format
• CMQCC Appendix B Obstetric Hemorrhage Care Guidelines Checklist – Staging algorithm checklist format
• Orlando Health Rapid Response Team Policy
• Orlando Health Epic Order Set Postpartum Hemorrhage
• UF Massive Transfusion Policy
• CMQCC Appendix U Sample Code Crimson Postpartum Hemorrhage Management – OB Emergency Code Guideline Example
• ACOG Obstetric Care Consensus 7: Placenta Accreta Spectrum
• ACOG Identifying and Managing Obstetric Emergencies in Nonobstetric Settings

1b: Ensure rapid access to medications and maintain readily available hemorrhage cart or equivalent

Evidence/Rationale

• Kogutt et al. 2022 Development of an Obstetric Hemorrhage Response Intervention: The Postpartum Hemorrhage Cart and Medication Kit
• Shields et al. 2025 Effectiveness of the Intrauterine Balloon Tamponade Compared With an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device for Postpartum Hemorrhage
• Overton et al. 2024 Intrauterine Devices in the Management of Postpartum Hemorrhage

Toolkit Resources

• Storage and Stability of PPH Medications
• CMQCC Appendix R Medications for Postpartum Hemorrhage
• CMQCC Appendix E OB Hemorrhage Cart, Kits, and Trays

Additional Resources

• Emergency Cart Examples
  • AdventHealth Tampa OB Emergency Cart
  • BUMED Obstetric Hemorrhage Cart Example – Used by military hospitals
  • UF OB Hemorrhage Cart Inventory List
• Revised ACOG PPH Recommended Instruments Checklist – coming soon
• UF Freestanding ED PPH Management Policy

1c: Conduct interprofessional, interdepartmental team-based training and drills to prepare for recognition and treatment of OB hemorrhage

Evidence/Rationale

• TJC HR 11.03.01 EP 2 and 4: Applicable staff are trained annually on the protocols and provisions implemented for emergency services readiness and the hospital is able to demonstrate staff knowledge on the topics implemented.

Toolkit Resources

• AHRQ TeamSTEPPS Rapid Response Module
• AIM Patient Safety Learning Modules – Free contact hour for RNs and MDs
• AWHONN Team Debrief Form

Additional Resources

• AWHONN OPS Course
• CMQCC Appendix G OB Hemorrhage Simulations and Drills Sample Scenarios
• CMQCC Appendix F Guidelines for OB Hemorrhage Simulation Scenario Development – Overview on how to create a Simulation Scenario
• CMQCC Appendix AA Sample Script Provider & Patient PPH Post-Event Debrief

1d: Implement a process for timely access to supplies, equipment and procedures for QBL documentation and communication at every birth

Evidence/Rationale

• ACOG Committee Opinion 794: Quantitative Blood Loss in Obstetric Hemorrhage
• Al Kadri et al. 2011 Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study
• Toledo et al. 2007 The accuracy of blood loss estimation after simulated vaginal delivery

Toolkit Resources

• AWHONN QBL Process Map – Scroll towards the bottom of the page to download pdf
• AWHONN QBL YouTube Video
• CMQCC Appendix M Sample QBL Worksheet

Additional Resources

• QBL Worksheet with Dry Weights Example from the Navy

General Resources

• The Joint Commission R3 Report: Provision of Care, Treatment, and Services standards for maternal safety PC.06.01.01 Reduce the likelihood of harm related to maternal hemorrhage
• ACOG Practice Bulletin Number 183: Postpartum Hemorrhage

2a: Assess hemorrhage risk on admission to L&D, Pre-Birth and on admission to postpartum and prepare based on risk level

Evidence/Rationale

• ACOG Practice Bulletin Number 233: Anemia in Pregnancy
• ACOG Practice Bulletin Number 9: Levels of Maternal Care

Toolkit Resources

• AIM Patient Safety Bundle Learning Module on Obstetric Hemorrhage – Free online module with CME/CE credits available through ACOG, Nursegrid Learn, or HealthStream

Additional Resources

• AWHONN Risk Assessment Tool & Postpartum Hemorrhage Stages Algorithm – You must provide your name and email address to download these free resources
• CMQCC Appendix C: Obstetric Hemorrhage Care Guidelines
• CDC Recommendations to Prevent and Control Iron Deficiency

2b: Measure blood loss with quantitative and cumulative techniques

Evidence/Rationale 

• AWHONN Practice Brief Number 13: Quantification of Blood Loss 
• ACOG Committee Opinion Number 794: Quantitative Blood Loss in Obstetric Hemorrhage
• Al Kadri et al. 2011 Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study

Toolkit Resources

• See Readiness section 1d for QBL tools
• AWHONN QBL Process Map – Scroll towards the bottom of the page to download pdf
• AWHONN QBL YouTube Video
• CMQCC Appendix M: Sample QBL Worksheet

Additional Resources

• Example of dry weights from Readiness (1d)

2c: Manage 3rd stage of labor

Evidence/Rationale

• AWHONN Practice Brief Number 12: Guidelines for Active Management of the Third Stage of Labor using Oxytocin
• Begley et al. 2019 Active versus expectant management for women in the third stage of labour, a Cochrane Review

2d: Provide verbal and written education to all patients on OB hemorrhage risk factors, early warning signs, postpartum complications risk, with added counseling for patients at higher OB hemorrhage risk

Evidence/Rationale

• Eaton et al. 2024 Qualitative Analysis of Women's Experiences of Education About POST-BIRTH Warning Signs

Toolkit Resources

• AWHONN POST-BIRTH Warning Signs
• ACOG Respectful Care eModule

Additional Resources

• CDC Hear Her Campaign

General Resources

• ACOG Practice Bulletin 183 on Postpartum Hemorrhage
• The Joint Commission R3 Report: Provision of Care, Treatment, and Services standards for maternal safety PC.06.01.01 EP 6 Reduce the likelihood of harm related to maternal hemorrhage
• Morton et al. 2020 National Partnership for Maternal Safety: Consensus Bundle on Support After a Severe Maternal Event

3a: Utilize a standardized, facility wide, stage-based, obstetric hemorrhage emergency management plan, with checklists and escalation policies for stage-based management of patients with obstetric hemorrhage

Evidence/Rationale

• TJC LD 13.01.01 EP 20-22: The hospital has adequate provisionsand protocols consistent with nationally recognized and evidence-based guidelines to meet the emergency needs of patients.

• ACOG Consensus Statement on Levels of Maternal Care
• ACOG Webinar on Placenta Accreta Spectrum Disorder Clinical and Designation Guidelines
• Overton et al. 2024 Intrauterine devices in the management of postpartum hemorrhage

Toolkit Resources

• CMQCC Toolkit version 3.0 pages 113 - 165

Additional Resources

• FPQC Levels of Maternal Care Resources
• LOMC Transfer Protocols – coming soon
• Example Policy for Tamponade Balloon or Vacuum Device – Winnie Palmer Hospital
• Rapid Response Team Policy Examples – Winnie Palmer Hospital
• Triton QBL Calculator Examples – Winnie Palmer Hospital
• JADA System - The JADA® System is intended to provide control and treatment of abnormal postpartum uterine bleeding or hemorrhage when conservative management is warranted
• AWHONN QBL Process Map – Scroll towards the bottom of the page to download pdf. You must provide your name and email address to download these free resources
• ACOG Massive Transfusion Protocol
• H Magnet from South Miami Hospital: Placed outside the door to alert others that the patient is at high risk for hemorrhage
• For hemorrhage carts see 1b

3b: Clinical Team Debrief and Huddles 

Toolkit Resources

• AWHONN Sample Team Debrief Form
• AIM Condition-Specific Questions in Severe Maternal Morbidity Review

Additional Resources

• ACOG Obstetric Team Debriefing Form
• See below for patient brief resources (3c)

3c: Provide trauma-informed support for patients, identified support network, and staff for all obstetric hemorrhages, including discussions regarding birth events, follow-up care, resources, and appointments

Evidence/Rationale 

• Morton et al. 2024 National Partnership for Maternal Safety: Consensus Bundle on support after a severe maternal event
• Vedam et al. 2017a The mothers on respect (MOR) index: measuring quality, safety, and human rights in childbirth
• Vedam et al. 2017b The Mother’s Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care

Toolkit Resources 

• AHRQ SHARE Approach – 5-step communication model for shared decision-making

Additional Resources:

• AWHONN POST-BIRTH Warning Signs Infographic
• CMQCC Appendix I Discharge Planning During the Birth Hospital Stay
• OPQIC Patient Summary Form
• FPQC Patient Brief Tools on Obstetric Hemorrhage
  • OB Hemorrhage Patient Brief Guidelines and Checklist for Providers
  • OB Hemorrhage Provider and Patient Brief Sample Script
  • EPIC Guidelines - Briefing & Discharge Paperwork
• FPQC Post-Birth Bleeding Patient-Facing Flyer – This flyer can be used to help educate patients with hemorrhage risk factors on what to expect if they experience bleeding during or after birth
• FPQC Trauma-Informed Care Flyer for Clinicians
• FPQC MFC Webpage – Refer here for a full list of Respectful Care resources
• FPQC PACC Patient-Facing Copy of the Post-Birth Health Check – Symptoms to look out for and postpartum support help lines
• PQCNC Life After Postpartum Hemorrhage - Resource for patients to learn what to expect during recovery after a hemorrhage and identify topics they would like more information on
• Partnering in healthcare: A framework for better care and outcomes – Safer Care Victoria Canadian toolkit to help hospital teams engage patients
• Edinburgh Postnatal Depression Scale
• AHRQ Patient Reported Measure Resources (PREMs)
• Postpartum Support International (PSI) Webpage for Professionals
• PSI Birth Trauma Support – Virtual support group for patients
• Patient Family Advisory Committee
  • FPQC Patient Family Advisory Committee Implementation Checklist

Evidence/Rationale

• ACOG Committee Opinion 667: Summary from one of our OHI 2.0 Clinical Leads, Dr Hux 

"This ACOG Committee Opinion offers a framework for obstetric triage and transfer for facilities providing obstetric care. It provides an overview of decision-making in obstetric transfer, legal requirements of EMTALA, and development of obstetric triage protocols and algorithms. This document urges hospital-based obstetric units to collaborate with emergency departments and response systems and shares AWHONN’s Maternal-Fetal Triage Index as an example of a validated algorithm for obstetric triage. In OHI 2.0, hospitals can benefit from using this opinion in shaping their own protocols for triage of patients at high risk for obstetric hemorrhage and in transfer of patients to facilities that can provide a higher level of maternal care when necessary." 

• PC 14.01.01 EP 15: The hospital has written policies and procedures for transferring patients to the appropriate level of care as needed to meet the needs of the patient. The hospital also provides annual training to relevant staff regarding the hospital policies and procedures for transferring patients.

Examples of Hospital Transfer Policies

• General Facility Transfer Agreement Example
• Orlando Health (OH) Transfer Process Examples:
  • Transfer Process for Patients to another Acute Care Facility
  • Transfer of Patients from Non-OH Facilities
  • Transportation of Patients: Internal and External

Accreta Management

• OB Emergency Algorithm: Managing unexpected and intraoperative cases of placenta accreta spectrum (PAS) outside of PAS specialty centers from Placenta Accreta Spectrum (Einerson et al. 2023).
• Evidence-Based Perioperative Management of Placenta Accreta Spectrum Disorder (Gilner et al. 2025)
• Leaving Placenta In Situ for Management of Placenta Accreta Spectrum Disorder (Amro et al. 2025)
• Management of unexpected placenta accreta spectrum cases in resource-poor settings (Rozi et al. 2023)
• Society for Maternal-Fetal Medicine Special Statement: Emergency checklist, planning worksheet, and system preparedness bundle for placenta accreta spectrum
  • Antenatal Planning Worksheet (Interdisciplinary Team): Intended for use by PAS referral centers to guide the discussion at interdisciplinary team meetings
  • Checklist for Management of Unexpected or Undiagnosed PAS
• Society for Maternal-Fetal Medicine Special Statement: A maternal transport briefing form and checklist
  • Maternal Transport Briefing Form

Abdominopelvic Packing

• Emergency Intraop Management of Undiagnosed Accreta - coming soon