Evidence-Based Practice Poster Session (Posters #11-#20)
19 - QBL Not Just an OB Process
Description: Clinical Problem/Significance: Women die from obstetrical hemorrhage because effective interventions are not initiated early enough. The process standardizes the practice, as well as establishing accurate and timely recognition of excessive blood loss by clinicians which is crucial because it leads to the initiation of blood transfusions earlier.
Background: After a maternal hemorrhage, the OB and OR departments looked to develop the process for accurate and timely recognition of blood loss. It has been a year since the inception of QBL (quantitative blood loss) program, We want to re-evaluate and update the process.Clnical Question: Does the process work? Are the documented weights of the different items correct? Does this have applications for other surgical hemorrhages? Description of Evidenced-Based Protocol: Completed an assessment using an evidence-based tool for determining maternal hemorrhage risk on admission; Created a tool to add to the operative timeout on the risk for a maternal hemorrhage.Created a process on how to calculate a QBL. Created a grid for tracking blood loss. Purchased scales for all departments involved. Created a reference tool on the dry weights for different products used in the care. Reviewed our Massive Transfusion protocol. Implemented drills on the QBL and Massive transfusion protocol. Revised both the EMR( electronic medical record) and paper to include this measure so that we all were documenting the quantitative blood loss. Created a monthly audit process. Develop a competency post test and skills sheet.Implementation of Evidence-Based protocol: Create a toolbox for all the involved areas; Held multiple mini-didactic programs with hands on experience. Conduct multiple drills in each area on the process as well as the Massive Transfusion Protocol. Held special meetings with the physician providers in each area. Tracked the completion of the post test and skill sheet for all staff in the areas.
Results: We have been tracking results. We have had an increase in transfusions in the OB unit. We have not had an increase of transfusions in the OR or ED. We have not had any adverse events for the mothers or babies. We have had some issues with the anesthesia providers giving up control of when to transfuse. We are in the process of reeducating our anesthesia providers who had a 50% turnover.We have used it in 2 other surgical procedures without finding any use.
Conclusions: It is important to continue to educate new staff and new providers. We need the active involvement of providers in our drills. We are looking at the post surgical hemoglobin and hemocrit to evaluate the effectiveness of the process. It has standardized the hand-off of blood loss for the obstetrical area.Perioperative Nursing Implications: There is more work to be done to see if quantitative blood loss is more effective than estimated blood loss. Will the time and effort be able to be supported in