The purpose is to disseminate information about a multidisciplinary approach to the management of patients with placenta accreta and its variants: increta and percreta. This program will define accreta and its variants and also identify the incidence of accreta in the population. Development of preoperative and intraoperative checklists will be presented along with an in-depth educational plan.

Proposed change:

The proposed change includes the development of a multidisciplinary team including OB/GYN, MFM, GYN/ONC, Interventional Radiology, and Urology. Nursing specialties include outpatient nursing, inpatient nursing: Antepartum, Labor & Delivery and Postpartum Units. Nursing experts such as the Clinical Nurse Specialist were essential to the successful functioning of the team. Use of erythropoetin and Venofer will also be discussed.

Implementation, outcomes and evaluation:

The first case was scheduled for March with patient admission one week prior. However, the patient came in prior to her scheduled admission due to vaginal bleeding. The bleeding was moderate at the time of admission but became heavy through the night. The team was notified and an emergency cesarean hysterectomy was performed. The patient received 10 units of packed red blood cells (PRBCs). This case, though emergent, went well due to the briefing and pre-emptive work done assembling the team of multidisciplinary professionals for this complex patient. To date 5 other cases have been scheduled and performed with the use of preoperative and intraoperative checklists developed by nursing. In total only 4 units of PRBCs have been used subsequently.

Each of these cases has been carefully recorded including timing of events throughout the case. Each case is briefed to discuss pertinent findings peculiar to the case. Debriefing allows the opportunity for the multidisciplinary team to evaluate and perform a thorough review of the previous case and to discuss what went well and what might be improved.

Implications for nursing practice:

Consistent nursing practice among all of the nursing specialties is crucial especially regarding education. An education plan is developed and implemented for each patient taking into account the individual patient’s and family’s needs. Also preoperative and intraoperative checklists were developed by nursing for safety and quality and validated by the multidisciplinary team and are used for each case. Nursing is a critical member of the multidisciplinary team providing education and quality and safety measures before and during the scheduled case.

Keywords:

Placenta previa, placenta accreta, placenta increta, placenta percreta, preoperative checklist, patient education, cesarean hysterectomy.