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Identifying Perceived Barriers for Implementation of the National Consensus Safety Bundle on Obstetric Hemorrhage: Utilization of the Delphi Method
Abstract Number: T-36
Abstract Type: Original Research
INTRODUCTION: The most preventable cause of maternal death, postpartum hemorrhage (PPH), has an increasing incidence within the United States (US).(1) In response, the National Partnership for Maternal Safety (NPMS) developed an obstetric hemorrhage consensus bundle to provide every US birthing facility consistent, validated practice guidelines.(1) With the Delphi method, we sought to identify items from the bundle at our institution that could be improved, had perceived barriers to implementation, and had solutions with high feasibility and impact on patient care.
METHODS: After IRB exemption, we conducted a prospective consensus-building study based on the Delphi method. Experts (≥ five years of experience on the labor and delivery floor) comprised of anesthesiologists, obstetricians, nurses, and surgical technicians were asked to participate in four sequential questionnaires on the implementation of the obstetric hemorrhage safety bundle. The first round identified bundle components that experts perceived as not currently adequate and the perceived barriers to implementation. The second round established agreement on important components within each specialty, and the third round ranked the elements (with ≥ 60% agreement) on feasibility of implementation and impact on patient care. The final round shared insights across all four specialties for a final consensus. Descriptive statistics were performed.
RESULTS: A total of (39) experts have completed two rounds at this time: (11) anesthesiologists, (11) obstetricians, (11) registered nurses, and (6) surgical technicians. Results describing areas for improvement are shown in the table. Other areas were deemed to be sufficiently adequate or lacked strong consensus.
CONCLUSION: The NPMS obstetric hemorrhage bundle was created to help guide practice and system improvement for every US birthing facility. For successful implementation, each center needs to create quality improvement mechanisms that identify deficiencies and build a culture of change, through group consensus. Our preliminary findings have identified several urgent areas for improvement including assessment of hemorrhage risk and a support program for staff, patients, and families. The Delphi method is a useful method to build consensus among expert providers and create a structured, purposeful program to deliver tangible quality improvement. Future studies will evaluate the long-term success of this initiative.
1. Main EK et al, A&A 2015