December 15, 2014

Checking in with some of the NC members who are collaborating with the FPQC’s Obstetric Hemorrhage Initiative (OHI). 

*CMC-Pineville started their obstetric hemorrhage protocol in November 2013, and made impressive strides - doing 100% QBL and have seen statistically dramatic increases in their patient risk assessment and protocol compliance.  
*WakeMed is working on their protocol, their staff training, and hold drills and also unannounced monthly drills on obstetric hemorrhage.  

NC hospitals are continuing their commitment to decreasing maternal mortality by implementing evidence-based research resulting in practice change.

November 29, 2014

The Obstetric Hemorrhage Initiative (OHI) run by the Florida Perinatal Collaboration (FPC) had its annual meeting on October 27, 2014.  Several members from PQCNC who are working with FPC were in attendance. The NC members of the FPC will be discussing their progress on an upcoming conference call.

April 27, 2014

Obstetric Hemorrhage Initiative E-Bulletin

April 2014


OHI Project Announcements


 - Initiative Timeline: The initiative does not have a strict timeline or deadlines for each recommended component. You do not need to have all OHI elements in place already – these can be implemented in any order. Please work in a way that helps your hospital team create a successful change strategy. Monthly data collection is intended to help you keep track of your hospital’s progress.


 - Now Scheduling: In-person site visits with your OHI team! Contact Annette if you are interested in a hospital visit for technical assistance.


 - Clinician Resistance to Quantification of Blood Loss: In response to a concern that some physicians have trouble adopting QBL in the delivery room, OHI Clinical co-Lead Dr. Judette Louis has prepared a statement “Why do QBL in Obstetrics?” Please feel free to share this with your hospital teams:


Why do Quantification of Blood Loss in Obstetrics?

By Judette Louis MD, MPH

When I was practicing in Ohio, a quality improvement project was initiated for reduction of obstetric hemorrhage.  I was skeptical about some of the components and somewhat taken aback to having anesthesiologists or nurses telling me what the blood loss amount was. I had been estimating blood loss for years without any problems and did not see the value for the added time and attention that it would take.  That is, until the consistent measurements indicated that estimation was not as safe for my patients as measured quantification. Over time, I learned from the literature that estimations were often as much as 50% inaccurate, usually underestimating the true loss.  I have heard from nurses, that on day 2 the hematocrit is sometimes low and the patient symptomatic when estimations are used and quantifications ignored.  This has made a believer out of me and now, I consistently want to have quantified measurement of blood loss for vaginal and Caesarean deliveries.  Quantification is not a perfect measurement but is more accurate than guessing, and with the new tools offered to make the measures more accurate, it is getting better and better. Many of our national organizations are strongly encouraging us to use the most accurate quantifications we can.  Recent recommendations have come from working groups comprised of ACOG, CDC, SMFM, and AWHONN, as well as, multiple state perinatal collaboratives that quantitative measures are safer for patients. I think we need to have a culture change in the delivery suite.  We have the evidence that early recognition of significant blood loss and early intervention is safer for our patients.  We need to get over the old thinking that we are not good at our jobs if there is blood loss and move to the evidence based model that says we are best at our work if we recognize and respond appropriately.



Current Action Items for Hospital Teams

 - POLL: Please tell us which Electronic Medical Records system your hospital is using, so that we may connect OHI hospital teams who are on the same system. Many of you have asked us who is using Cerner, EPIC, etc. Please submit your response here.

 - Submit your March data (past due) and April data (due on May 15). Please see the attached OHI Monthly Data Collection Tool for a list of the database questions and useful tips.


Upcoming Events

·       Save the Date!  OHI Mid-Project Meeting: October 27, 2014


·       Next OHI Learning Session Webinar:

DATE: Thursday, May 8, 2014

TIME: 12:00 PM

TOPIC: Team Communication and Debriefing - Register Now!


·       Monthly Learning Session webinars are on the Second Thursday of each month at noon.


·       Perinatal Quality Improvement Symposium

Friday May 30, 2014 – Wellington, FL – Wellington Regional Medical Center

TeamSTEPPS training for application to OHI or other maternal healthcare QI project. Visit the FPQC Events page for more information. Registration required.




o   View our April webinar on Quantification of Blood Loss recording or download the slide set here. New resources for QBL have been added to the OHI Toolbox.


o   We are still offering FREE online courses on Quality Improvement from the Institute for Healthcare Improvement (IHI)

The Florida Perinatal Quality Collaborative is offering a limited number of 12-month paid subscriptions to the IHI Open School. The IHI Open School offers a range of online courses in improvement capability, patient safety, triple aim for populations, person- and family-centered care, leadership, and quality, cost, and value. Each course takes approximately 1 to 2 hours to complete and consists of three to five lessons that end with assessments. More information can be found at http://www.ihi.org. If interested, please complete the attached application.



Recent Articles

Bakri Balloon in the Management of Postpartum Hemorrhage: A Review

American Journal of Perinatology. April 2014 DOI: 10.1055/s-0034-1372422   


Implementation of an obstetric hemorrhage risk assessment: validation and evaluation of its impact on pretransfusion testing and hemorrhage outcomes

Erica Wu, Jennifer A. Jolley, Brooke A. Hargrove, Aaron B. Caughey, and Judith H. Chung. Journal of Maternal-Fetal and Neonatal Medicine. April 2014. (doi:10.3109/14767058.2014.905532)


Pelvic arterial embolization in severe obstetric hemorrhage

Maiju Grönvall, Minna Tikkanen, Maarika Metsätähti, Mikko Loukovaara, Jorma Paavonen andVedran Stefanovic. Acta Obstetricia et Gynecologica Scandinavica. April 2014 DOI: 10.1111/aogs.12376


Temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada from 2003 to 2010

Mehrabadi A, Liu S, Bartholomew S, Hutcheon JA, Kramer MS, Liston RM, Joseph KS, Maternal Health Study Group of the Canadian Perinatal Surveillance System (Public Health Agency of Canada). Journal of Obstetrics and Gynaecology Canada. 2014, 36(1):21-33



If you would like to subscribe to the OHI distribution list, please email [email protected] 


April 15, 2014

The four NC teams continue their work with the Florida hospitals on maternal hemorrhage - some highlights:.  

  • Rex:  Provided staff with education on quantification of blood loss, purchased hemorrhage carts and have available for use, EPIC flowsheet redesign, and on May 1st will begin weight measurements.
  • CMC-Pineville:  Continue work on mass transfusion protocol and comprehensive plan to spread to all CMC facilities, continue with simulation drills and debriefing these drills, created a risk assessment for L&D.
  • WakeMed:  Working on a system-wide mass transfusion protocol, debriefing all hemorrhages, unit based and simulation lab drills, purchased hemorrhage carts, performing risk assessments on patients, EPIC flowsheet redesign.
  • CMC:  MD champions revising/creating mass transfusion protocol, looking at current available equipment with possible new equipment purchases, reorganization of persons collecting and entering data, and performing chart reviews.
February 7, 2014

The FPQC is in the process of…

·         Consulting with the OHI advisory board in response to your clinical questions. We have updated recommendations based on two issues that have been raised this month:

o   Oxytocin dosage and timing during the third stage of labor – The OHI toolkit is being updated related to Active Management of the Third Stage of Labor (AMSTL) regarding oxytocin dosage and administration for prevention of postpartum hemorrhage (see pages 10, 11, 14). It is recommended that oxytocin be administered at delivery via IV infusion, 40 units in 1000 cc of IV fluid. If a partial infusion is hanging, the dosage should be adjusted accordingly. If there is no IV in place, 10 units of oxytocin administered IM is the recommended dosage.

o   Mixed methods estimation/quantification of blood loss – Quantification of blood loss is the recommended process for all deliveries. For the OHI, if estimation of blood loss is only partially quantified, please report this as Estimation Blood Loss (EBL). Blood loss is QBL only if blood loss was exclusively quantified.

·         Answering your data collection questions. Please contact Emily Dunn ed[email protected] or 813-974-9654 with any database questions.

·         Creating Data Reports for your hospital baseline data. Reports will be sent to your hospital data lead by February 13th

·         Providing technical assistance. If you have a clinical question, are in need of technical assistance, or are interested in Grand Rounds, please  contact Annette Phelps at [email protected]

·         Updating the OHI Toolbox for Hospital Implementation. New additions include: California’s newly released Preeclampsia Toolkit; AWHONN Quantification of Blood Loss Recommendations

·         Planning upcoming webinars. Would your hospital team members be willing to join our panelist discussion on March 13 on how OB hemorrhage simulations and drills are going in your hospital? If so, please contact us. Dates of upcoming webinars are below.


·         Announce initiative and have a hospital OHI kick off!

·         Conduct clinical staff education.

·         Attend monthly OHI learning session webinars.

·         Collect data for December 2013 and January 2014 and input into data collection tool by February 15th.The official link to the monthly data entry is http://tinyurl.com/OHI-Monthly-Data-Collection Please bookmark this link, as you will use it every month!


Next OHI Learning Session Webinar - Register Here for the February OHI learning session.

DATE: Thursday, February 13, 2014

TIME: 12:00 pm-1:00 pm

TOPIC: Engaging Physicians and How to Interpret your Hospital’s Data Reports.

January 13, 2014

Submit Your Hospital’s Baseline Data

We are now collecting your Obstetric Hemorrhage Initiative official baseline data. Please have your site's baseline data submitted by January 15, 2014.  

Follow this link to input your hospital’s official baseline data: http://tinyurl.com/OHI-Official-Baseline

Register for the January Webinar

Register Here for the January OHI learning session.

DATE: Thursday, January 16, 2014

TIME: 12:00 pm-1:00 pm

TOPIC: Massive Transfusion Protocols.

Hospitals will have the opportunity to share implementation successes, challenges, and ask questions.

November 28, 2013

Florida Perinatal Quality Collaborative Newsletter November 2013 featuring updates on the Maternal Hemorrhage Initiative...


November 5, 2013

Four teams from NC travelled to the official kick-off meeting of the joint Florida/NC Maternal Hemorrhage Initiative in Winter Park, Florida for an exciting work filled day.  Highlights of the day included reviewing the action plan, participating in a simulation drill, and the chance to network and share with colleagues engaged in this important work.    Our teams from NC returned home to excited to begin work - work that will continue over the next two years to decrease the morbidity and mortality from maternal hemorrhage.

October 2, 2013


Congratulations to the following facilities for being chosen to participate in the Florida-North Carolina Maternal Hemorrhage Initiative:  Carolinas Medical Center-Pineville, Rex, Wake Med and Carolinas Medical Center-Main.  These teams will embark on a two-year initiative in January to implement a robust toolkit to decrease maternal mortality associated with hemorrhage.

August 26, 2013

There are a very limited number of spaces for NC hospitals to reserve to be a part of this initiative so it is imperative that you review the two documents avaialble on the resources pane of this page - FPQC OHI Hospital Implementation Guide and Questionnaire for OHI Hospitals.  The implementation guide discusses the time commitment and the action plan.  Please review the questionnaire and determine if your facility meets the requirements.  If you determine that you will be able to meet the time commitment, action plan and requirements to apply for a space in the initiative please email to confirm.  This is a very limited opportunity and we must have your confirmation by September 3rd.