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Implementing PPH Bundle across your Entire Healthcare System

LASHEA WATTIE M.ED, MSN, AG -CNS-BC, APRN, RNC, C -EFM

SYSTEM CLINICAL NURSE SPECIALIST, WOMEN AND NEWBORNS

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Provide the WHY!!

EDUCATE MOTIVATE EMPOWER

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Trends in pregnancy-related mortality in the United States: 1987–2010

Causes of pregnancy-related death in the United States: 2006–2010

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Standardization§ PATIENT SAFETY

§ RISK REDUCTION

§ SAFE CLINICAL OUTCOMES

Processes

§ ORDER SETS

§ PROTOCOLS

§ EDUCATION, PATIENT TEACHING

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Key OB Hemorrhage QI Toolkits:Full of Resources

www.CMQCC.org www.pphproject.org

v2.0 available soon

www.safehealthcareforeverywoman.org

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Educate!

Healthcare Providers

ALL Ancillary Staff

Nursing Staff Patient

Remember Team work and Collaboration EACH AND EVERY MEMBER OF THE HEALTHCARE TEAM PLAYS A ROLE IN MAKING A CULTURE CHANGE!

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Motivate

Data

CelebratePDAC

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4 Domains: OB Hemorrhage Patient Safety Bundle

Improve readiness to hemorrhage by identifying standardized protocols (general and massive)Improve

Improve recognition of OB hemorrhage by performing on-going objective quantification of actual blood loss

Improve

Improve response to hemorrhage by utilizing unit-standard, stage-based, obstetric hemorrhage emergency management plans with checklists

Improve

Improve reporting/systems learning of OB hemorrhage by performing regular on-site multi-professional hemorrhage drills

Improve

Obstetric Hemorrhage Key Elements

Readiness - Every Unit

1. Hemorrhage cart with supplies, checklist, and instruction cards for intrauterine balloons and compressions stitches

2. Immediate access to hemorrhage medications (kit or equivalent)

3. Establish a response team - who to call when help is needed (blood bank, advanced gynecologic surgery, other support and tertiary services

4. Establish massive and emergency release transfusion protocols (type-O negative/uncrossmatched)

5. Unit education on protocols, unit-based drills (with post-drill debriefs)

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QBL Calculator

Obstetric Hemorrhage Key Elements

Recognition - Every Patient

5. Assessment of hemorrhage risk (prenatal, on admission, and at other appropriate times)

6. Measurement of cumulative blood loss (formal, as quantitative as possible)

7. Active management of the 3rd stage of labor (routine use of oxytocin)

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Practice Brief Quantification of Blood Loss (QBL)

Suggested Equipment

Calibrated under-buttocks drapes to measure blood loss

Dry weight card, laminated and attached to all scales, for measurement of items that may become blood-soaked when a woman is in labor or after giving birth

Scales to weigh blood-soaked items, ideally in every labor and operating room and on the postpartum unit; save costs by using the scales used to weigh newborns

Formulas inserted into the electronic charting system that automatically deduct dry weights from wet weights of standard supplies such as chux and peri-pads

RecognitionHIGH RISK BANNER

MOH RISK ASSESSMENT SCORING TOOL

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Obstetric Hemorrhage Key Elements

Response - Every Hemorrhage

9. Unit-standard, stage-based, obstetric

hemorrhage emergency management plan with

checklists

10. Support program for patients, families, and staff

for all significant hemorrhages

Transfusion Therapy

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Empower!

EBP

Tools

Resources

Education

Light at end of the

tunnel!

Use all Avenues for Buy In!

OB DEPARTMENT MEETINGS

STAFF MEETINGS HOSPITAL NEWS LETTERS

SIGNAGE

EMAIL HUDDLES IN-SERVICES IMPROMPTU

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Mulit-System Standardization

System Department Meetings

Physician Champions at each facility

Nurse Champions at each facility

Take lessons learned from one facility to the next

Nurse Champions/Preceptors Effective Training

Support Team for each Facility

Provide Scripting!

Train champions so the messaging and scripting is standardized!

You want encouraging, successful nurses as your champions, not nurses wanting to pick up a few extra shifts!

Ensure your nurse champions understand the culture and challenges of each facility they are supporting.

Taylor your roll-outs to the needs of the nursing team, physicians and community!

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Ready ..Set…Go!

Once you have buy in start with facilities with most leadership support OR the most buy-in from healthcare providers and community.

Set realistic goals for each facility

Give yourself enough time to obtain lessons learned and modify work-flow if necessary

Communicate regularly have touch point calls to work through issues in real time

EDUCATE….MOTIVATE….EMPOWER

(https://www.youtube.com/watch?v=srDxXgE_t4M )

Celebrate Your WINS!!!!

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