Hospital Implementation Toolkit

Toolkit Purpose

This toolkit houses a robust repository of resources specifically curated to support birthing hospitals’ implementation of the Connecticut Urgent Maternal Warning Signs Bracelet Initiative at their facilities and in partnership with community-based organizations and healthcare providers. In addition to the materials featured on the main webpage, resources in the toolkit include training webinars, a hospital implementation process guide and checklist, digital posters for facility displays, shareable social media graphics, and more. The toolkit may be accessed via the main webpage or directly through this link: cthosp.org/bracelet/toolkit

The Bracelet Initiative — a state-funded effort led by the Connecticut Perinatal Quality Collaborative (CPQC) and the Connecticut Hospital Association (CHA) — aims to reduce maternal morbidity and mortality by improving clinical awareness of potential postpartum complications and conditions. Starting in the fall of 2025, birthing hospitals across the state are providing postpartum patients with an orange bracelet and an informational handout before leaving the hospital. The bracelet signals to healthcare professionals and first responders that the wearer is newly postpartum, enhancing timely recognition of and response to symptoms of potentially serious postpartum complications, known as “urgent maternal warning signs.” Complications may include eclampsia, blood clots, sepsis, cardiomyopathy, and perinatal depression. The Bracelet Initiative educates healthcare providers, including emergency department (ED) staff, and emergency medical services (EMS) personnel on standardized lifesaving protocols, ensuring postpartum patients seeking emergency services are identified and triaged appropriately. The initiative is funded through grants awarded to CHA by the Connecticut Departments of Public Health (DPH) and Children and Families (DCF). 

Why Wear for 12 Weeks?

Orange bracelets are worn for a shorter period (12 weeks) because while serious complications can happen up to a year postpartum, the most critical, immediate life-threatening issues — like hemorrhage, blood clots, and eclampsia — often peak or present within the first few weeks to months, aligning with the recommended duration of wearing the bracelet to alert providers to ongoing risk after hospital discharge.

• The first 12 weeks — often called the “fourth trimester” — is a period of intense physical recovery when complications like postpartum preeclampsia, infection, or hemorrhage are most prevalent.
• While complications persist, the 12-week mark often coincides with the end of initial intensive postpartum care and the highest risk for the most immediate, severe crises.
• Some hospitals do encourage wearing the orange bracelet for up to a year, but the 12-week mark is a common standard for alerting providers to ongoing risk.

Blank Bracelets Rationale

Blank orange bracelets are available as an option to those who do not leave the hospital with a newborn due to situations such as a stillbirth, surrogacy, adoption, or loss of custody of a child at birth.

Hospital staff, EMS personnel and ED staff, and community-based healthcare providers are invited to watch on-demand recordings of the introductory virtual webinars held in September 2025. At the end of each training, participants will be able to: identify that an individual wearing an orange bracelet is postpartum, recognize urgent maternal warning signs, and connect postpartum patients experiencing complications to care. Registration is required to access the recordings. Click the links below to register.

Continuing education credits are available for one year from the live training dates. After one year, the sessions will still be accessible, but continuing education credits will no longer be offered.

Hospitals can integrate educational materials into both provider training and patient education. Use these tools to reinforce urgent maternal warning signs with patients and families. Organizations are welcome to add their logos to these materials. High-resolution copies of all materials are available upon request by emailing communications@cthosp.org.

Planning and Stakeholder Engagement

Goal: Build a coordinated, cross-sector foundation for implementation.

Key Actions:

• Meet with hospital leadership to seek necessary approvals for project rollout
• Form Implementation Team: Include OB-GYNs, nurses, social workers, and other critical staff
• Distribution Protocol:
  • Establish supply chain (i.e., storage, distribution points, and tracking) and method of dissemination for bracelets and patient-facing educational materials
• Clinical Integration:
  • Build clinical response pathways (who responds to a patient presenting with a bracelet)
• Community Partner Engagement: Map partner roles in outreach and education; include EMS, community health workers (CHWs), doulas, Women, Infants and Children (WIC) staff, pediatricians, and public health professionals
• Engage hospital and system marketing/communications teams early to:
  • Develop a shared communications plan and key messages
  • Coordinate internal staff communications (emails, newsletters, intranet)
  • Plan external outreach (press releases, social media campaigns, community announcements)
  • Ensure consistent branding of bracelet materials across hospitals and community partners
  • Support dissemination of flyers, brochures, and digital assets to both patients and community partners

Outputs:

• Written implementation plan
• Partner contact list and roles
• Finalized patient materials
• Bracelet distribution protocol
• Written communications plan and approved materials

Provider Trainings

Goal: Equip providers with knowledge and consistency in responding to urgent maternal warning signs.

Key Actions:

• Hospital Staff Training:
  • Train nurses, OB-GYNs, social workers, and administrators; incorporate recorded webinar
  • Review urgent maternal warning signs, bracelet meaning, and response protocols
  • Develop training schedule for newly onboarded hospital staff
  • Provide refresher sessions for ongoing reinforcement
• ED and EMS Staff Training:
  • Share recorded webinar with ED and EMS staff to educate about urgent maternal warning signs and patient triage
  • Review urgent maternal warning signs, bracelet meaning, and response protocols
• Community-Based Provider Training:
  • Share recorded webinar with CHWs, doulas, pediatricians, home visiting staff, and other community-based organization staff who work with birthing persons during the postpartum period
  • Discuss referral pathways and reinforce role in education and response

Outputs:

• Attendance records and evaluation surveys
• Training schedules for newly onboarded staff and refresher sessions for existing staff

Patient and Family Education

Goal: Empower families with knowledge and tools to recognize urgent maternal warning signs and advocate for care.

Key Actions:

• Before patient leaves the hospital:
  • Provide bracelet and patient education materials (best practice is to place bracelet on patient’s wrist)
  • Verbally review urgent warning signs with patient and family
• In the Community:
  • In partnership with CHA and the CPQC, share materials through WIC offices, home visiting programs, community baby showers, doulas, and other community outreach sites

Outputs:

• Discharge plan that includes bracelet distribution
• Share with clinics and community sites information about educational materials available on the CHA website

Bracelet Initiative participants may have needs that require assistance from state agencies or national programs. Additional maternal and infant health resources are listed below.

To obtain and use the official Bracelet Initiative logo on related materials, please email communications@cthosp.org.

Recycling Bracelets

While silicone is technically recyclable, it’s not commonly accepted in curbside recycling programs. If you are interested in establishing a recycling program at your hospital, the following businesses recycle silicone products, including bracelets.

• WristbandBros
• GoSili
• Zero Waste Box by TerraCycle

Bracelet Initiative Background

In 2024, several Connecticut hospitals contemplating the creation of postpartum bracelet programs in their facilities requested that the Connecticut Perinatal Quality Collaborative (CPQC) scale the concept into a statewide initiative. CPQC participants supported the coalition pursuing the idea as a quality improvement (QI) project to complement the group’s ongoing efforts to address maternal morbidity and mortality in the postpartum period.

Hartford HealthCare and Trinity Health Of New England implemented bracelet programs in their respective health systems in the spring of 2025. The hospital leaders who built those programs collaborated with the CPQC and CHA to shape and execute the kickoff of the statewide Bracelet Initiative that fall. All initiatives are identical in purpose, design, and scope.

Initiative Rationale

According to the Connecticut Maternal Mortality Review Committee’s 2015-2020 Pregnancy-Related Deaths in Connecticut report, more than half of pregnancy-related deaths occur during the postpartum period, and most are considered preventable. This is consistent with national data. The Bracelet Initiative was designed to increase community awareness of preventable postpartum complications and conditions; ensure that birthing persons are empowered to seek help when experiencing symptoms of postpartum complications; and educate healthcare providers on potential complications during the postpartum period. Postpartum bracelet programs have produced positive results in other geographic areas. For example, East Carolina University Health Medical Center in North Carolina reduced postpartum readmissions from 2.24% in 2019 to 1.47% in 2022 after implementing postpartum bracelets. Other initiatives on urgent maternal warning signs have demonstrated improved timely ER recognition and triage of postpartum patients. For example, FHN Memorial Hospital in Illinois saw an increase in the percentage of postpartum patients moving from registration to triage in 10 minutes or less, from 38% to 61%.

Statewide Goals

GOAL 1: Increase awareness of urgent maternal warning signs among birthing persons and their family members.

Action Steps:

• Prior to discharge, birthing hospitals provide all postpartum patients with an orange bracelet and an informational handout detailing urgent maternal warning signs
• Healthcare providers encourage patients to wear the bracelet for 12 weeks postpartum
• Providers educate partners and other family members on urgent maternal warning signs

GOAL 2: Enhance the ability of healthcare providers, particularly those not specializing in maternal health, to recognize and respond to potential complications during the postpartum period.

Action Steps:

• In collaboration with hospitals, the CPQC trains healthcare providers and emergency services personnel on urgent maternal warning signs and treatment protocols
• In collaboration with hospitals, the CPQC develops and disseminates resources to reinforce the training
• In collaboration with hospitals, the CPQC offers ongoing training on related topics identified by healthcare providers

GOAL 3: Empower birthing persons to advocate for their health needs during the postpartum period.

Action Steps:

• Healthcare providers encourage patients to wear the bracelet for 12 weeks postpartum
• In collaboration with hospitals, the CPQC cultivates community partnerships on the state and local level
• In collaboration with hospitals, the CPQC and hospitals leverage a social media and digital advertising campaign to amplify the initiative’s reach and achieve maximum visibility

The Connecticut Urgent Maternal Warning Signs Bracelet Initiative toolkit was developed with financial support provided by the state Department of Public Health and Department of Children and Families. This publication does not express the views of the Departments or the State of Connecticut. The views and opinions expressed are those of the authors. CDC Hear Her materials available through the toolkit have been developed by the federal government.