1. Quantification of Blood Loss in practice

2. 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

3. 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.

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

5. 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.

6. EBL vs qbl

7. readiness
Every unit: Hemorrhage cart with supplies

8. recognition
Every vaginal delivery

9. recognition

10. recognition
Every C/S
Every C/S

11. 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

12. 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

14. 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

15. QBL and Early Recognition saves lives