Obstetric Hemorrhage Initiative E-Bulletin - April 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



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