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Development of a Post-Partum Hemorrhage/Uterine Atony Cognitive Aid
Abstract Number: SA-48
Abstract Type: Original Research
Introduction. Post-partum hemorrhage (PPH) is an important contributor to maternal morbidity and mortality. Deficiencies in clinical practice are associated with 60–80% of fatal obstetric hemorrhages. Lack of treatment algorithms, organization, and knowledge/training have been identified as contributors(1,2). Providing a cognitive aid for uterine atony, the most common cause of PPH, may help trainees under conditions of stress and unfamiliarity. Cognitive aids are prompts which guide individuals through complex tasks(3). We describe the development of a Post-Partum Hemorrhage/Uterine Atony Cognitive Aid and present the final product for dissemination.
Methods. The development of a PPH cognitive aid for uterine atony was identified as a priority. Although there are existing consensus statements and guidelines for PPH, we tailored the content for our practice environment, made it more trainee-friendly, and simplified the design(2-4). Among existing work, the Stanford Emergency Manual does not include a PPH tool(5). Areas of perceived weakness were prioritized for inclusion. A flow chart was developed incorporating evidence from the literature, clinical practice guidelines, and institutional recommendations with careful consideration given to design and visuals with a graphic designer(6). A process was followed comparable to the development of similar tools(2, 3, 5). The product was presented for feedback and improved in an iterative process leading to the final design.
Results. The cognitive aid was received favourably by trainees, with feedback from users being positive. Medical and surgical treatment options are depicted in detail, including dosing. A logical order for intervention, communication, and escalation of care is provided in addition to treatment goals. The final product (Figure 1) is in the format of an 11”x17” poster, and is available for free download on our website www.PPHTool.com.
Discussion. We hope our cognitive aid will facilitate teaching in the operating room, make trainees familiar with crisis resource management, and enable timely and appropriate treatment of PPH.
1.) Am J Obstet Gynecol 2013; 209:449.e1-7.
2.) Curr Opin Anesthesiol 2014; 27:267-274.
3.) Anesth Analg 2013; 117:1162-1171.
4.) BJOG 2013; 123:254-256.
5.) Stanford Anesthesia Cognitive Aid Group. Emergency Manual: Cognitive aids for perioperative critical events. http://emergencymanual.stanford.edu BY-NC-ND. 2014 (V. 2).
6.) BJOG 2006; 113:919–924.