“Code Creta” and Massive Transfusion Prevention

Purpose for the program: The increase of cesarean deliveries and other uterine surgeries has resulted in the increase in the incidence in accretas. Placenta accreta occurs when placenta implantation is abnormal. Placenta accreta is a serious pregnancy complication that is associated with massive and potentially life threatening hemorrhage. It is the main reason for emergency hysterectomies.

Proposed change: It is imperative that organizations are prepared to manage patients with accretas and/or massive blood loss. In response to the growing numbers of accretas, we developed a “Code Creta” protocol to minimize risk to the mother and infant for patients with accretas, either known or unknown.

Implementation, outcomes and evaluation:

The protocol includes an algorithm to assist in the necessary interventions based upon the severity of the accreta. It begins with early detection and diagnosis of suspected accreta. The physician consults with Gyncology Oncologist to determine the extent and best course of action for the patient. The Radiologists is consulted to determine if perioperative interventions are needed and Anesthesia is consulted to assist with appropriate form of anesthesia. Nursing assists with early detection and monitoring the patient for changes in clinical status and coordination of care.

In addition to the surgical plan, the protocol includes a “Code Hemorrhage” protocol to assist with rapid turnaround times for blood testing and transfusion. As soon as a “Code Hemorrhage is called, a specific number in blood bank has been established to assist with rapid running of the blood specimen. A pre-established number of blood products are prepared and sent. There is a dedicated member on the OB team for the Blood Bank to communicate with during the “Code”.

The creation of the Code Creta policy has decreased the number unexpected cesarean hysterctomies, unintended ICU admissions and use of Blood Products. Our next phase of this protocol is to utilize simulators for the OB/GYN physicians to manage massive blood loss until a GYN Oncologist is available to assist with the surgery. We anticipate further reduction in massive Blood loss and use of blood products with further training.

Implications for nursing practice: The standardized approach to high risk situations assists in decreasing stress, poor communication and negative patient outcomes. The Code Creta can be replicated in other organizations as a way to approach patients with accretas or massive blood loss.

Keywords: accreta, massive blood loss, cesarean hysterectomy