Implementing DOH Guidelines for Hemorrhage Recognition and Prevention in the Community Hospital

Responding to the NYSDOH’s mandate that all hospitals need to come up with a clear plan as to how to deal with maternal hemorrhage, we undertook the challenge of how to accomplish this at a community hospital with limited resources.

Our first step was to research the problem. After a thorough review of articles that had been published over the past few years pertaining to maternal hemorrhage. Mary and I developed a power point presentation to use for educating the staff. We were able to apply to the NYSNA for CEUs for our in-services. It was clear that the education had a major and positive impact on our units’ awareness and response to hemorrhage.

Simultaneously, we established a protocol of having planning sessions when any “high risk” patient was nearing delivery. These meetings were multidisciplinary, involving staff from the lab, nursery, ICU, anesthesia, L&D, PP, OR, house supervisors, as well as other disciplines as indicated. We developed a flow sheet to be used as a guide for these team meetings.

Next came developing a policy to clearly lay out the plan and everyone’s role. We had to plan for the worst case, middle of the night disasters as well as the controlled, perfectly planned deliveries accomplished during normal business hours. We spelled out exactly how to activate the Code H. We needed to anticipate for all the “what-ifs” and include clear step by step directions of who to call and what to do. It spawned a new set of concerns: Does everyone know how to use a blood warmer? How much Pit can be given? What other drugs can be used? How do we transfer the patient after surgery to ICU? Who’s running for blood, etc? Our document is currently making its way through the various hospital committees.  We anticipate final approval by the end of summer. This will then involve a second round of education for all team members.

The only thing left is for us to put our hypothesis to the test. We are currently developing our mock CODE H drills. We are in the process of requesting a grant from one of our local benefactors in order to purchase a Noelle mannequin to be used during such drills. We plan to start running drills in late fall. Planning has begun on a multidisciplinary level.  

This has been a much more involved project than I could ever have imagined. But I think we have come up with a systematic and comprehensive plan; one that could be accomplished at most community hospitals, yet one that rivals the best plans of the finest teaching hospital.For our poster presentation, we would like to present our step-by-step experience, as well as the elements we feel are essential to the success to any hemorrhage protocol.