Deadly Deliveries? -- Working as a Team to Make a Difference In Preventing and/or Treating Obstetrical Hemorrhage

Purpose for the program: In 2006, maternal death rose to 13.3 deaths per 100,000 live births.  Obstetrical hemorrhage has been associated with this increased maternal death rate.  Reviewing the literature, it is stated some of these deaths could have been prevented.  Women come to the hospital thinking they are safe and will be going home with a new baby and beginning a new era in her life.  Little does the woman realize that by walking into a hospital, she has an increased chance of dying due to maternal complications.  This program was designed to look broadly at the problem of obstetrical hemorrhage and to put into place a standardized approach to prevent and/or treat an obstetrical hemorrhage. 

 Proposed change: As we started this program we became a member of the California Maternal Quality Care Collaborative(CMQCC) focusing on obstetrical hemorrhage. Working together with the beside nurse champion we developed a process map of how we believed women in the perinatal department were cared for when an obstetrical hemorrhage was identified.  Once the process map was refined, it was taken to the following focus groups: nursing, residents, and attending physicians.  After these focus groups the process map was further refined and gaps were identified.  Following the process mapping we went through a Failure Modes Effects Analysis (FMEA) which identified our high risk areas in regards to obstetrical hemorrhage.  Between the gaps identified during the process mapping and the identification of the high risk areas, we were able to develop a plan to standardize our approach to an obstetrical hemorrhage.

Implementation, outcomes and evaluation: Through our process we were able to coordinate with key departments to develop the following: OB Hemorrhage Risk Assessment, Trauma Registration for Obstetrical Patients (Doe Packs), Blood Requisition and Transfusion Protocols for Obstetrical Patients and an obstetrical hemorrhage algorithm.  The most valuable tools that came out of this project were the OB hemorrhage cart and the OB hemorrhage risk assessment.   The program went live in April 2010 after the Skills Fair.  One of the highlights that really drove the impact of obstetrical hemorrhage was the blood quantification station, in which most participants under estimated the blood loss.  During the last accreditation survey this year the perinatal department was recognized as having best practices for preventing and treating an obstetrical hemorrhage.

Implications for nursing practice: This project demonstrates the impact a team, especially including  a bedside nurse champion, can make to improve the care of our perinatal patients.

Keywords: Ob hemorrhage, risk assessment, FMEA