Quantifying Blood Loss at Birth Saves Lives

Abstract

Poster Presentation Objective To assess the effectiveness of a brief workshop designed to reinforce the clinical skills of labor and delivery staff and increase accurate documentation of quantification of blood loss (QBL) to enable staff to recognize significant hemorrhage and implement timely interventions. Design Postpartum hemorrhage is an obstetric emergency and is estimated to cause 25% of all maternal deaths in the United States. The accepted practice of estimating blood loss (EBL) has been demonstrated to be grossly inaccurate, and QBL has been determined to be the most accurate clinical assessment in the management of postpartum hemorrhage. Incorporating QBL into clinical management ensures that women receive appropriate care and helps prevent maternal mortality. Sample All 120 labor and delivery (L&D) registered nurses (RNs) in a tertiary care center with 6000 births annually. Methods Nurses participated in a 30‐minute clinical skills QBL workshop. Sessions incorporated brief didactic instruction, clinical skill practice, including electronic medical record (EMR) documentation. A retrospective analysis of individual patient records (three before and three after workshop participation) was performed for all participating staff to assess workshop effectiveness. Implementation Strategies Workshops were held on the physical L&D unit during periods of low census. Standardized teaching tools were created and all assistant unit managers were oriented to teaching roles. Theses instructors were responsible for teaching workshops during a 6‐month period. Results Nurses attending the workshops learned that their estimations of blood loss deviated significantly from actual QBL (range −2165 ml to +1597 ml). Efficacy in performing QBL was established (100%) for all learners. Retrospective chart analysis revealed a significant increase in EMR documentation from 77% to 87.6% for workshop participants. Compliance for QBL documentation in L&D as a whole increased from 67% to 88% during the course of the workshops. Conclusion/Implications for Nursing Practice The workshop was effective in teaching clinical skills and EMR documentation of QBL. The workshop allowed for an integrated learning experience that was well received by staff and could be implemented in an extended huddle format. This on‐the‐unit approach may have contributed to the overall increase in QBL documentation even for staff who did not attend the workshops.