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Using a Care Pathway as part of an
integrated approach to reduce
inappropriate blood transfusion in
stable postpartum women
Mairi Harkness, Transfusion Specialist Midwife, Better Blood transfusion Programme, SNBTS
Imogen Hayward, Consultant Anaesthetist, Borders General Hospital, Melrose
May Mok, Consultant Anaesthetist, Perth Royal Infirmary, Perth
Vicki Clark, Consultant Obstetric Anaesthetist, RIE
Simpson Centre
for Reproductive
Health
Royal Infirmary of
Edinburgh
Major haemorrhage is the leading
cause of serious maternal morbidity
in Scotland
But, at SCRH, 75% of those
transfused are stable postpartum
mothers with no ongoing blood
loss
Blood Transfusion &
Mothers
Audit of stable
postpartum transfusion
? EVIDENCE OF INAPPROPRIATE TRANSFUSION
Pre-transfusion Hb range: 66-86 g/dl
17/18 women had 2or3 units RCC
8 women had discharge Hb>100g/dl
3 women had discharge Hb greater than booking Hb!
POOR DOCUMENTATION:
No symptoms of anaemia documented (55%)
No reason for transfusion documented (50%)
How practice could be
improved
1. Decision to transfuse
Guidance on Hb transfusion triggers
Reassessment between units
2. Improving documentation
Symptoms of anaemia
Reason for transfusion
Administration & observations
3. Supporting safe transfusion
Guide midwives through the process
An Integrated Approach
1. Formal guidelines for postnatal transfusion
2. An integrated care pathway for prescribing and
administering blood
3. Multidisciplinary Education
Multidisciplinary
Approach
Medical staff (anaesthetists & obstetricians)
decision to transfuse & consent
Midwifery staff
administer blood
monitor observations
influence medical staff!
Both groups document the process
Multidisciplinary Care
Pathway
Multidisciplinary Care
Pathway
Multidisciplinary Care
Pathway
Audit of Transfused
Postpartum Women
Initial Follow Up
Audit Audit
Pre-transfusion Hb 66-86g/dl 57-76g/dl
Symptoms of anaemia documented? 8/18 (44%) 10/13 (77%)
Reason for transfusion documented? 9/18 (50%) 13/13 (100%)
Total number of RCC
Units Transfused
Initial Audit
45 units transfused to 18
women
2.5 units per woman
Follow up Audit
19 units transfused to
13 women
1.4 units per woman
Going Forward
•Ongoing evaluation & review of pathway
•Ongoing education & updates
•Other clinical areas interested