implementation of postpartum hemorrhage bundle€¦ · participation of physician champions from ob...
TRANSCRIPT
Introduction Planning and Implementation
Every hospital caring for obstetric patients should incorporate a
postpartum hemorrhage bundle into hospital policy.
Quantification of blood loss at all deliveries.
Simulations of postpartum hemorrhage should be conducted
quarterly using an interdisciplinary approach.
A hemorrhage cart be readily available and stocked with all
necessary supplies.
Nursing education done with all shifts targeting difficult tasks.
Participation of physician champions from OB and anesthesia
teams in California Maternal Quality Care Collaborative
(CMQCC).
.
Implementation of Postpartum Hemorrhage Bundle Touro University School of Nursing
Amy Ciraulo, MSN, RN
Overview
Evaluation of Bundle with
Simulation
Met Not met
Properly assess hemorrhage risk 3 0
Requests hemorrhage cart 3 0 Proper set up of warmer for rapid blood replacement
2 1
Quantifies blood loss 3 0 Debrief completed 3 0
Results
Ishikawa Diagram
The target population for this project was the nursing staff of a 9-bed labor and
delivery unit. During simulation drills of postpartum hemorrhage, all
components of the bundle were met except for one. The component that was
not met was during the night shift simulation and was the proper use of the
“Ranger” fluid warmer for blood product administration.
During the development, implementation, and evaluation of this bundle
discoveries were made that lead to improved workflow, communication, and
processes. Additional equipment was purchased including a hemorrhage cart,
scale, and simulator.
Education to staff at meetings and at daily shift huddles was conducted to
ensure consistency of information.
Preset orders were changed for all admissions to labor and delivery to allow
for proper assessment and intervention based on risk factors and blood typing
requirements of blood bank.
Risk assessments were incorporated into the electronic medical record and
instructed to be done on all patients at admission and at handoff.
Gantt Chart
References
Recommendations
Berg, C. J., Callaghan, W. M., Syverson, C., & Henderson, Z. (2010).
Pregnancy-related mortality in the United States, 1998-2005.
American College of Obstetricians and Gynecologists, 116, 1302-
1309. Retrieved from
http://www.cdph.ca.gov/data/statistics/Documents/MO-CAPAMR-
PregnancyRelatedMortality-Berg2010-1998-2005.pdf
California Department of Public Health. Maternity mortality rates are
increasing. (2010). Retrieved from
www.cdph.ca.gov/data/statistics/Pages/CaliforniaPregnancy-
AssociatedMortalityReview.aspx
Bingham, D., Lyndon, A., & Lagrew, D. (2011, September/October).
A State-Wide Obstetric Hemorrhage Quality Improvement Initiative.
The American Journal of Maternal/Child Nursing, 36(5), 297-304.
http://dx.doi.org/10.1097/NMC.0b013e318227c75f
Contact and Acknowledgements
Amy Ciraulo, MSN, RN [email protected]
I wish to acknowledge the nurses, physicians, and management
of the NorthBay Labor and Delivery unit for their support.
Ann Stoltz, PHD, RN, CNL Touro University California, School of
Nursing Director
According to California Department of Public Health (CDPH, 2010).
The rate of maternal deaths in the United States has nearly
doubled from 1996 to 2006.
The state health department contracted with the California
Maternal Quality Care Collaborative (CMQCC) to examine deaths
related to pregnancy.
Bingham, Lyndon, and Lagrew (2011) stated, “Beyond identifying
who died, the causes of death, and where and when deaths
occurred, experts on the mortality review panel determine the
degree to which each death may have been preventable. They
also provide their best judgment of contributing factors and quality
improvement opportunities or lessons to be learned from each
death” (p. 298).
Together with the root cause analysis and the consensus that
obstetric hemorrhage had the highest probability of being
prevented a safety bundle for obstetric hemorrhage was developed
and implemented and evaluated.
The desired outcome was for nursing staff to identify patients at risk
for postpartum hemorrhage, recognize the level of hemorrhage
earlier, intervene quickly, and report postpartum hemorrhages with
a subsequent debrief of the incident. The intervention employed
was the development and implementation of a safety bundle for
obstetric hemorrhage.
“As health care quality improvement and patient safety efforts
intensify, understanding the social and health care contexts
surrounding women who die as a result of pregnancy is critical to
instituting the systemic changes needed to decrease pregnancy-
related mortality.” (Berg, Callaghan, Syverson, & Henderson, 2010,
p. 1308).
Statement of the Problem
Implementing a safety bundle for postpartum hemorrhage
takes collaboration of multiple disciplines throughout the
hospital.
Stakeholders included nurses, physicians, OB techs,
administrators, laboratory, simulation lab, central supply, and
blood bank.
Overall the success of this bundle is credited to the hospital
and the staff’s willingness to learn and make positive changes
based on evidence to ensue the safest care for their patients.
Bundle Components
Readiness
Recognition
Response
Reporting
Hemorrhage Cart
Simulation Drills
Risk Assessment
Quantification of Blood Loss
Blood Product
Replacement
Debriefing