Quantification of Blood Loss in practice

Objectives: Describe the magnitude of the problem Demonstrate the difference between EBL vs QBL Take a look at the process, methods, and tools Give suggestions for how to effectively implement and utilize QBL in your organization

Alliance for Innovation on Maternal Health Program AIM The U.S. has the highest maternal mortality rate of any high resource country – and the rate is increasing. HALF of maternal deaths are PREVENTABLE! AIM GOAL: is to eliminate preventable maternal mortality and severe morbidity across the U.S.

Patient Safety Bundle Obstetric Hemorrhage Readiness – every unit Recognition and Prevention – every patient Response – every hemorrhage Response Reporting/Systems Learning – every unit

Magnitude of the Problem A leading cause of maternal morbidity and mortality is failure to recognize excessive blood loss during childbirth. Women die from obstetric hemorrhage because effective interventions are not initiated early enough.

EBL vs qbl

readiness Every unit: Hemorrhage cart with supplies

recognition Every vaginal delivery

recognition

recognition Every C/S Every C/S

Subtract before placenta delivery from total Keeping track… Computerized tracking – documentation (IT) Keeping track of total – bedside card Dry weight charts Note time of delivery Pause… Vaginal delivery – note volume in drape C/S – change suction tubing to 2nd canister or note volume in canister Subtract before placenta delivery from total

QBL in your organization Develop a multidisciplinary taskforce with physician and nursing champions from OB and anesthesia Don’t reinvent the wheel – use available resources to assist you in your hospital’s individualized QBL plan Simulation is a great way to educate, practice new behaviors Add QBL in your OB emergency drills and unit competencies Debriefings are critical for continuous quality improvement

CMQCC California Maternal quality care collaborative Quantification of blood loss for all Active management of the 3rd stage for all Vital sign triggers “Move along” on uterotonic medications Intrauterine balloon/B-Lynch suture A new approach to blood products The value of a formal protocol Toolkit at www.cmqcc.org/ob_hemorrhage

QBL and Early Recognition saves lives