Standardization and Automation of Postpartum Rh Immune Globulin Management to Reduce Clinician Administrative Burden and Patient Risk of D Alloimmunization (Why do it yourself when Epic can do it for you?)

AIM Statement: By November 2025, 100% of postpartum patients with Rh-negative blood types will have automated ordering of postpartum Rh evaluation and Rh immune globulin when indicated, reducing reliance on manual processes and minimizing missed administration within the recommended 72-hour postpartum window. Background Individuals with Rh-negative blood types who are exposed to fetal Rh-positive red blood cells during the perinatal period are at risk for anti-D alloimmunization, which can lead to significant fetal or neonatal morbidity or mortality. Historically, our institution relied on recognition of Rh-negative blood type by the healthcare provider and subsequent ordering of the postpartum Rh evaluation and Rh immune globulin (“Rhogam”) if indicated. Without clinical decision support systems and electronic health record (EHR) automation in place, the process resulted in preventable gaps in Rhogam administration. Methods This stepwise quality improvement project began after the Obstetric Physician Quality Chief identified recurrent missed Rhogam administration despite repeated resident physician education on the importance of Rh-negative recognition, testing, and postpartum Rhogam administration in the inpatient setting. Rotating groups of resident physicians led to inconsistent knowledge transfer and inevitable relapses in human error. Working with the EHR team, the initial PDSA cycle began with linking the postpartum Rh-evaluation order to a reflex Rhogam order for qualifying patients. This removed one manual step, but left room for error in initial recognition of Rh status. In the second PDSA cycle, the team further automated the process through leveraging the standard Type & Screen admission order. The postpartum Rh-evaluation with linked Rhogam was placed automatically through a standardized postpartum order set, for all patients with Rh-negative blood types. To improve closed-loop communication, a new column with visual cues indicating Rhogam status (not needed, ordered, or given) was added to the shared nursing-provider postpartum patient list. Results Baseline data beginning January 2024 showed appropriate Rhogam administration for 97% of qualifying postpartum patients. While this is nearly perfect, missed Rhogam administration could be devastating for patients’ future pregnancy outcomes. Following full implementation in October 2025, 100% of Rh-negative patients have had the Rh-evaluation order set placed without manual action from the physician team. All patients requiring Rhogam (n=62) have received it during their inpatient hospitalization. Qualitatively, reduced cognitive load and manual steps for physicians due to automated clinical decision support and improved communication tools decrease contributing factors to provider burnout. Conclusion Standardization and automation of Rh-evaluation and Rhogam ordering, combined with improved communication tools, eliminated missed inpatient postpartum Rhogam doses at our institution. Clinical decision support systems and automated communication tools reduced cognitive load and manual processes for physicians.