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Maternal Affinity Group

Maternal Affinity Group. September 25, 2013. Objectives. Name at least 3 of the core elements of Postpartum Hemorrhage Identify the need for a risk factor Postpartum Hemorrhage admission assessment   Understand the necessity of accurately assessing blood loss for Postpartum Hemorrhage.

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Maternal Affinity Group

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  1. Maternal Affinity Group September 25, 2013

  2. Objectives • Name at least 3 of the core elements of Postpartum Hemorrhage • Identify the need for a risk factor Postpartum Hemorrhage admission assessment   • Understand the necessity of accurately assessing blood loss for Postpartum Hemorrhage

  3. Why is this important? • Postpartum Hemorrhage occurs in about 18% of births • Common cause of maternal morbidity • massive transfusions • secondary surgical procedures • ICU admissions • fertility loss

  4. Early Intervention is the KEY Early intervention requires the following: • Recognition of risk factors leading to heightened surveillance; • Standardized approach to estimating blood loss; • The use of clinical triggers or alerts such as: • heart rate(>/= 110) • blood pressure (</= 85/45 or >15% drop) • oxygen saturation (<95%)

  5. Core Elements • Develop a policy for PPH with the at least the following components: • Definition of PPH for your institution • Risk Factors • Initial Interventions • Medical Treatments • Surgical Treatments • Defined Care Team and Role Clarity • Checklist Algorithm • Transfusion Policy • Drills

  6. Obstetric Hemorrhage Key Element Checklist Highest Priority: • Unit-standard OB Hemorrhage protocol • Hemorrhage Cart • Partnership with Blood Bank • Post-event debrief/huddle • Assessment of hemorrhage risk on admission • Assessment of cumulative blood loss

  7. Hemorrhage Risk Assessment

  8. Hemorrhage Cart OB Hemorrhage Cart: Recommended Instruments (California Maternal Quality Care Collaborative - CMQCC) • Set of vaginal retractors (long right angle); • long weighted speculum • Sponge forceps (minimum: 2) • Sutures (for cervical laceration repair and B-Lynch • Vaginal Packs • Uterine balloon • Banjo curettes, several sizes • Long needle holder • Uterine forceps

  9. Hemorrhage Medication Tray As recommended by CMQCC • Pitocin 20 units per liter NS 1 bag • Hemabate 250 mcg/ml 1 ampule • Cytotec 200mg tablets 5 tabs • Methergine 0.2 mg/ml 1 ampule

  10. Partnership with Blood Bank • Have a partnership with your blood bank for especially for PPH • Involve them in the protocols (even development of them) • Make sure they have what you need and can get it quickly • They also make for a great partner in data collection

  11. Assessment of Blood Loss • Often blood loss in underestimated • Develop a standard in your hospital • Important to have training involving the estimation of blood loss • >500 ml for vaginal birth • >1000 ml for cesarean birth may be the most common clinical definition in the U.S

  12. Estimating Blood Loss Methods for quantifying blood loss: • Percent saturation of blood soaked items with visual cues: pictures, posters • Weighing blood soaked pads/chux • Collecting blood in graduated measurement container Important to standardize methods in hospital that everyone understands and is trained to use!

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  15. Slide 15 British Journal of Anaesthesia;HemostaticMonitoring During Postpartum Hemorrhage and Implications for Management;C. Solomon, R. E. Collis, P. W. Collins;DisclosuresBr J Anaesth. 2012;109(6):851-863

  16. Post-Event • Important to debrief the event • Establish a culture of ALWAYS performing a huddle/debrief using a tool: • CMQCC Debrief Form • Mini-RCA • IHI Trigger Tool

  17. Slide 17

  18. References • http://mail.ny.acog.org/website/Optimizing_Hemorrhage/Simulation_Drills.pdf • http://mail.ny.acog.org/website/optimizing_hemorrhage/definition_early_recognition.pdf • http://www.pqcnc.org/documents/fpqc/FPQCOHIHospitalImplementationGuide.pdf • http://www.cmqcc.org/resources/ob_hemorrhage/protocols_guidelines

  19. Questions? Lynne Hall lhall@gha.org 770-249-4525

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