Background: Initially, two cases were evaluated of OB Severe Hemorrhage to assess current practice related to OB Severe Hemorrhage policies. Staff education and practice changes were implemented. Two additional cases occurred which allowed another opportunity to assess for improvement in nursing/collaborative care implementation. During these additional emergency situations , staff and collaborative team members response was evaluated based on the previous clinical recommendations.  The final case review is an outlying case, involving multiple nursing units, the OB Severe Hemorrhage occurred six hours after delivery, on a postpartum unit. 

Case: All cases involved initiation of OB Severe Hemorrhage policy which is initiated at the request of the OB provider.  Cases were evaluated for risk factors of postpartum hemorrhage.  Lab results at admissions, during hemorrhage, and until discharge of patient home were assessed to look retrospectively at quantification of blood loss verses the stated estimated blood loss.  Cases were also evaluated for timeframe recognition of postpartum hemorrhage to actually initiation of the OB Severe Hemorrhage policy. The policy activates collaborative team members including: Obstetrics, Anesthesia, Labor/Delivery Nursing, ICU Resource Nursing, Nursing Supervisor, and Laboratory/Blood Bank personnel.  Cases were reviewed for pharmacological and non-pharmacological interventions prior to any need for surgical interventions as well as resuscitative measures during interventions.  Also evaluated was the response timeframe for collaborative team members including laboratory, blood bank, and radiology. 

Conclusion:  After completion of first two case reviews, recommendations for nursing were brought to Labor and Delivery Clinical Practice.   Emphasis was placed on encouraging direct, focused, and early communication with providers and collaborative team members; working to quantify blood loss early in hemorrhage to allow for quicker decision in initiation of multidisciplinary services in policy.  Additional recommendations included: improved role management; communication through centralized location; organization of quick reference checklist and nursing documentation worksheets for better capture of event time lines; and implementation of OB Severe Hemorrhage Cart, determination of centralize location of cart for rapid access to equipment .  The OB Severe Hemorrhage Cart is assessable to OB focused nursing units.

       It is significant to note that the same nurse was in attendance for each case which allowed for critical analysis of practice, focused implementation of practice changes and real-time evaluation. Significant decrease in timeframe from recognition of hemorrhage to actual initiation of policy occurred.  Communication significantly improved resulting in increased safety for patients and satisfaction from team members involved.

Keywords: Communication, Collaborative, Organization, OB Severe Hemorrhage