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Practical Guide for the Implementation of an Obstetric Hemorrhage Protocol
Abstract Number: T-05
Abstract Type: Original Research
Evidence supports improved outcomes with obstetric hemorrhage protocol (OHP).1 Resources, including toolkits, are available that describe implementation of an OHP.2 Challenges to implementation include system-issues and cultural barriers. We describe our 5 year experience with introduction and use of an OHP.
Systems’ issues during OHP implementation extended beyond labor & delivery (L&D)–such as lab, pharmacy, subspecialty consultants and perioperative resources. Like many, our L&D unit functioned in isolation. Cultural barriers to OHP included lack of: team engagement at local and health system’s level; subspecialists’ reluctance to relinquish territory; coordination in patient management; and acceptance of the need for new management approach.
A critical step was to establish and maintain a multidisciplinary team. Members ranged from patient aids to hospital administrators. Careful attention to processes identified opportunities to improve care. An example is use of color-coded lab slips for easy recognition of sample destination. A simple approach for assignment of roles was created by use of laminated cards with roles and designated tasks that are handed to individuals as they arrive to help. This enabled a culture of engagement. Cognitive aides and flow sheets facilitate adherence to OHP. Post-event debrief and team meeting have maintained engagement and ownership of the process.
Our OHP has been activated over 100 times. Successful launch and adherence to OHP occurs at all hours and days of week. Changes to OHP have included use of TXA, fibrinogen concentration, ROTEM and engagement of other personnel (eg. pharmacist to aid in obtaining and dosing adjuvants).
Recognizing each practice is unique our experience in implementing and refining an OHP may be useful to others struggling to apply published recommendations or tools.2 We highlight the value of protocol in engaging and inducing cultural change.
1. Shields LE, et al. Comprehensive maternal hemorrhage protocols reduce the use of blood products and improve patient safety. AJOG 2015;212(3):272-280
2. Main EK, et al. National partnership for maternal safety: Consensus bundle on obstetric hemorrhage.JOGNN 2015;44(4):462-470