A Softer Approach to Quantitative Blood Loss Measurement

Abstract

Implementation of quantitative blood loss (QBL) in vaginal births proved to be successful in our facility; however, physician and staff buy-in remained challenging. We knew the operating room (OR) would magnify this issue while providing its own hurdles. Team members agreed measuring blood loss was a better process, but how to effectively roll out QBL in the OR was the question. Our goal was to have physician and OR staff buy-in without affecting patient care or efficiency in workflow, or requiring purchase of expensive equipment, while preserving physician autonomy. A multidisciplinary team at Baylor University Medical Center recognized the need to move from estimated blood loss (EBL) to QBL measurement for operative cases. It was decided that QBL would be introduced by pilot program to expose staff members to the QBL workflow. Team members were then trained on QBL measurement to plan and operationalize the process together. Interdisciplinary buy-in was imperative for this project to be successful. A dedicated pilot nurse attended all scheduled OR cases with the purpose of exposing the team to QBL while keeping their routine the same. The case proceeded as normal while the pilot nurse measured all blood loss and calculated QBL. When the case ended, the pilot nurse provided the QBL while the physician provided the EBL as comparison. Pre/post–patient hematocrit data were collected to reassure staff and physicians of QBL accuracy. After months of the pilot program, QBL simulation training was provided to nurses and certified surgical technologists for final roll-out. Physician and staff willingness to implement QBL dramatically increased after the pilot phase, not only in the OR but also in vaginal births. During the pilot phase, evaluation of QBL versus EBL was noted to identify the variances; improved assessment of blood loss resulted in earlier recognition and intervention, thus decreasing intensive care unit admissions. Involvement of nursing–medical–OR staff at the inception of the project was key. Passive exposure of the QBL techniques through the pilot phase decreased anxiety and showcased the ease of the process, which increased willingness to adapt to this change. Hands-on simulation training in the OR followed the pilot phase and solidified the process.