Accurate Assessment of Blood Loss: Saves Lives!!

Purpose for the program:

Every obstetric department works to provide safe outcoms for mothers and babies.  Some smaller, community hospitals may not have optimal resources available around the clock to handle an obstetric emergency such as a maternal hemorrhage requring massive transfusion.  Increasing situational awareness can make a significant difference in preventing a crisis.

Proposed change:

Collaboration between multidisciplines that provide patient care can facilitate changes to improve staff preparedness.  This is be done by implementing protocols identifying patients at risk for hemorrhage and guidelines to improve teamwork and communication.  The  proposed change was to ask staff to weigh all blood loss items during the postpartum recovery period on all patients, use an effective communication tool and document accurately on a standardized form.

Implementation, outcomes and evaluation:

With the support of management, a patient care model was implemented to provide better coverage where needs were identified.  Department protocols provided guidelines promoting evidence based care.  A rapid response protocol was implemented emphasising early activation, collaborative team response and effective communication and documentation was enhanced by the EMR.  OB Emergency Drills using patient simulators were used to practice using methods for accurately assessing blood loss.

Implications for nursing practice:

Using a systematic approach of quantifying blood loss by weight helped to identify the inaccuracies of estimations.  Once the problem was identified staff was able to implement methods to facilitate the proposed change by supplying scales in all the postpartum recovery rooms and a postpartum hemorrahge cart was created for rapid access to supplies needed in emergent situations.

Keywords: accurate assessment, collaboration, teamwork, protocols, simulation, resources