OB Hemorrhage:A Collaborative Approach to Standardization

Presented by:Kristi McClure, RN, MSN, C-EFMClinical Educator, MCWJune 26, 2014

Mount Carmel Health System

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MCHS OB Collaborative

The Collaborative Approach

• Who–Multidisciplinary team–Physician champions

The Standardization Process

• What –The equipment–The process–The team–The documentation

The Standardization Process

• Where–Hospital–Health System–Region/State–Nation

But WHY?•Aviation•ACOG•AWHONN

How do We Start? (Project Planning)

• Regular monthly meetings• Leadership buy-in• Budget planning• Timeline/scheduling• Physician Engagement

Project Components

• Education Program • OB Hemorrhage policy• Rapid Response Team• Massive Transfusion Protocol• Written review process (Peer Review)• Written process for weighing blood soaked

items when hemorrhage identified

Accomplishments

Equipment - OB Hemorrhage Cart

Policy Development

• Policy written to include:– Risk assessment of all patients– Weighing all materials for accurate EBL– Staging of hemorrhage based on EBL– Reference to Massive Transfusion Policy*

OB Alert

OB Alert

Trinity OB Hemorrhage Education PlanEducation Requirements Responsible Persons Time Requirement per

ParticipantApprox. Number of MCSA

Participants

HealthStream Online Pre-Test(Nov 1, 2013 – Mar 31, 2014)

Required:•Nurses (L&D, MIU, RRT)•Physicians (Residents, Employed, Independent)•CNMsEncouraged: Anesthesia Providers

30 minutes Nurses = 190Physicians = 113CNMs = 15Anesthesia = 21

Recommended Readings &HealthStream Online Didactic Lecture(Nov 1, 2013 – Mar 31, 2014)

Required:•Nurses (L&D, MIU, RRT)•Physicians (Residents, Employed, Independent)•CNMsEncouraged: Anesthesia Providers

90 minutes Nurses = 190Physicians = 113CNMs = 15Anesthesia = 21

OB Hemorrhage Skill Stations(Apr 30, 2014 – Sept 30, 2015)

Required:•Nurses (L&D, MIU, RRT)•Physicians (Residents, Employed, Independent)•CNMs•OBT, MST, PCAEncouraged: Anesthesia Providers

30 minutes Nurses = 190Physicians = 113CNMs = 15Anesthesia = 21OBT, MST, PCA = 38

HealthStream Online TeamSTEPPS Lesson(Apr 30, 2014 - Sept 30, 2015) (Must be completed before simulation)

Required:•Nurses (L&D, MIU, RRT)•Physicians (Residents, Employed, Independent)•CNMs•OBT, MST, PCA•Unit CoordinatorsEncouraged: Anesthesia Providers

30 minutes Nurses = 190Physicians = 113CNMs = 15Anesthesia = 21OBT, MST, PCA = 38 Unit Coordinators = 17

Simulation & Debriefing(Apr 30, 2014 – Sept 30, 2015)

Required:•Nurses (L&D, MIU, RRT)•Physicians (Residents, Employed, Independent)•CNMs•OBT, MST, PCA•Unit CoordinatorsEncouraged: Anesthesia Providers

90 minutes Nurses = 190Physicians = 113CNMs = 15Anesthesia = 21OBT, MST, PCA = 38Unit Coordinators = 17

HealthStream Online Post-test(complete 3-6 month after simulation/debriefing– no later than Mar 31, 2016) – Must achieve a score of 80%

Required:•Nurses (L&D, MIU, RRT)•Physicians (Residents, Employed, Independent)•CNMsEncouraged: Anesthesia Providers

30 minutes Nurses = 190Physicians = 113CNMs = 15Anesthesia = 21

TOTALS 5 hrsover 2 ½ years

Total Time: 1,824 hrsover 2 ½ years

339

339

377

394

394

339

Skills Stations

Simulation

Documentation

Documentation

Ultimate Goal