Peripartum Hemorrhage Reduction Project Thomas Ivester, MD, MPH - - PowerPoint PPT Presentation

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Peripartum Hemorrhage Reduction Project Thomas Ivester, MD, MPH - - PowerPoint PPT Presentation

Aug 26, 2023 220 likes •475 views

Peripartum Hemorrhage Reduction Project Thomas Ivester, MD, MPH Shelley Summerlin-Long, MPH, MSW, RN A Hemorrhage Story Definition Peripartum hemorrhage (PPH) blood loss around the time of delivery of 1000 ml or more 10% drop in a

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Peripartum Hemorrhage Reduction Project

Thomas Ivester, MD, MPH Shelley Summerlin-Long, MPH, MSW, RN

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A Hemorrhage Story

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Definition

  • Peripartum hemorrhage (PPH)

» blood loss around the time of delivery of 1000 ml or more » 10% drop in a patient’s hematocrit » Need for immediate transfusion

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Prevalence of PPH

3.5 6 7.3 10.5

2 4 6 8 10 12

U.S. Globally UNC Africa

Percentage

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UNC OB Hemorrhage Rates, 2010-2015

7.5 7.1 7.9 7.6 6.2 7.3

UCL 9.39 CL 7.27 LCL 5.14 4.4 5.4 6.4 7.4 8.4 9.4 10.4

2010 2011 2012 2013 2014 2015

Percentage Year

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Why is this important?

  • NC Women’s Hospital – 3rd largest consumer of blood

products in the hospital

  • Hemorrhage a leading cause of maternal morbidity

and mortality in U.S. and globally

  • Responsible for 25% of maternal deaths

» Most of these are preventable!

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Project Aims

Short-term:

 Develop the necessary tools and resources to ensure UNC can provide efficient, effective response to PPH

Primary: Reduced incidence of PPH and associated maternal morbidities Decreased use of blood products Secondary:

 Increased use of preventative and early intervention measures  Enhanced teamwork among obstetrical providers and staff  Improved identification of high-risk patients

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INITIAL STEPS

6/1/2016 8

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Hemorrhage Cart and Tackle Boxes

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Virtual Med Kit

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Simulation Program

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Prioritizing Next Steps

Chart Reviews (100) + Hemorrhage Surveys (173) + Provider Observations (10) + Simulation Evaluations (5) Data Analysis Root Cause Analysis Solutions Brainstorming Multi-voting Next Steps: (1) Hemorrhage Protocol (2) TeamSTEPPS (3) Clinical Education

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Hemorrhage Protocol

  • Risk identification
  • Standardization of treatment
  • Role clarification
  • Development of checklists
  • Based on evidence-based

practice

  • Makes it easier for people to do

the right thing

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Stage 1: Primary RN Charge RN Second RN OB, FM or CNM

  • Call primary provider to

bedside

  • Notify charge RN
  • Med/IV fluids
  • Vitas q5
  • O2 PRN Sat >95%
  • Fundal massage
  • In/outs
  • ID and treat as per

etiology

  • I&O catheter

T&C x 2u

  • PPH Med kit & fluids
  • Warm blankets
  • Weigh pads and EBL

q5-10

  • Document
  • Assign 2nd RN
  • PPH Cart
  • Notify as needed:
  • Anes
  • OB/FM
  • Scrub
  • Blood bank
  • Assign runner for blood bank

PRN

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TeamSTEPPS

  • Trainings in May and June for all Labor & Delivery

providers and staff

» OB, Family Medicine, Midwives, Anesthesia, Nursing, Staff

Simulation Debrief Some of theTeamSTEPPS Coaches

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Clinical Education

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Hemorrhage Rates at UNC Jan 2015-Jan 2016

5.0 5.8 8.1 6.5 9.3 9.3 7.7 4.7 9.1 7.6 7.8 5.7 7.7

UCL 12.20 CL 7.25 LCL 2.31 0.7 2.7 4.7 6.7 8.7 10.7 12.7 14.7

Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan

Percentage Month

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Blood Transfusions at NC Women’s Hospital

Transfusion rate = % deliveries receiving any blood product; # blood products issued includes red blood cells, plasma, and platelets

2.0 3.2 2.7 4.1 4.6 3.0 5.1 4.8 11 24 20 28 44 38 32 42

10 20 30 40 50 60

Jun Jul Aug Sept Oct Nov Feb Mar # Blood Products Issued on L&D, Postpartum Blood Transfusion Rate on L&D, Postpartum

December and January data not available

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Simulation Scores,

  • Oct. 2015 - Apr 2016

54 55 76 78 87 87 94

10 20 30 40 50 60 70 80 90 100

Oct Nov Dec Jan Feb Mar Apr

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From an Intern. . .

The simulation sessions

  • ffered me that
  • pportunity. I certainly

felt that in real-life postpartum hemorrhages after the simulations, I was more conscious of the clinical situation and my actions and communication techniques within it.

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I had the opportunity to participate in several simulations. I think so often in intern year we are faced with [complicated] clinical scenarios . . . Our moment-to- moment lives at work are so filled with responsibilities that sometimes it's difficult to digest what you did well and what you could have improved on.

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Another Hemorrhage Story

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Sustainability Plan

  • Interdisciplinary Team

» Champions in each department: OB, Nursing, Anesthesiology, Midwives, Family Medicine, Pharmacy, Simulation, QI

  • Commitment to continue simulations
  • Investment in clinical education
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Dissemination Plan

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Lessons Learned

  • Challenges in

creating a sim culture

  • Strengths in bringing

all disciplines to the table

  • Importance of

gathering data at the source

  • Need for structural &

administrative support for QI