A Retrospective Analysis on the Effectiveness of a Maternal Hemorrhage Plan

Abstract

Poster Presentation Objective In 2011, a multidisciplinary team at a 728‐bed nonprofit Magnet hospital developed a standardized maternal hemorrhage plan (MHP) aimed at early identification and rapid treatment of excessive bleeding, with the ultimate goal of decreasing the incidence of massive maternal hemorrhage. The purpose of this study was to correlate the effectiveness of the MHP on maternal outcomes and blood utilization. Design A pre‐ and postintervention retrospective data analysis to compare maternal outcomes and blood utilization in women experiencing massive postpartum hemorrhage Sample All women at greater than 16‐weeks gestation treated in the obstetrics unit requiring transfusion of ≥ three units of blood products due to postpartum hemorrhage ( n = 99). The sample was divided into two groups: pre‐implementation (January 2009 – December 2011; n = 62) and postimplementation (January 2012 – June 2014; n = 37). Exclusion criteria included transfusions due to ectopic pregnancy, miscarriage, postsurgical hemoperitoneum, blood dyscrasias, and secondary postpartum hemorrhage following discharge. Method Retrospective chart reviews using obstetric transfusion records from transfusion services were performed. Data were extracted regarding estimated blood loss, quantitative blood transfusions, international normalized ratio (INR) results, intensive care unit (ICU) admissions, length of stay, disseminated intravascular coagulation (DIC) and hysterectomy rates. Preimplementation data from 2009 to 2011 were compared to postimplementation data from 2012 to 2014. Implementation Strategies Using an interdisciplinary approach, formal education on the unit inservices were conducted, followed by video recorded simulations, debriefings, and ongoing education. Results Since implementation of the MHP in 2011, there has been a notable decline in all outcomes. Sixty‐two women were transfused for massive hemorrhage prior to implementation, compared to 37 since implementation. There has been a steady decline in total obstetric transfusion rates from 1.5% in 2010 to 0.8% in 2014. Additionally, preimplementation blood product usage for massive hemorrhages totaled 561 units, compared to only 298 units postimplementation. Early identification and treatment of maternal hemorrhage has resulted in decreased instances of DIC (14 vs. 9), fewer hysterectomies (12 vs. 7), a reduction in hemorrhage related ICU admissions (26 vs. 16), and decrease in average length of stay (4.56 vs. 4.0 days). Conclusion/Implications for Nursing Practice Early identification and treatment of hemorrhage with implementation of a MHP protocol resulted in improved maternal outcomes.