Identifying Barriers to Implementation of the National Partnership for Maternal Safety Obstetric Hemorrhage Bundle at a Tertiary Center: Utilization of the Delphi Method

Abstract

The NPMS obstetric hemorrhage bundle was created to help guide practice and systems improvement for US birthing facilities. The Delphi method enabled identification of deficient elements and perceived barriers to element implementation, as well as group consensus on elements with highest patient impact and feasibility. Multidisciplinary group consensus can identify deficiencies and promote tangible, quality improvements in a large, tertiary-care labor and delivery unit. Institutions may utilize our described technique to guide implementation of future care bundles.

Hospital‐level variation in rates of postpartum hemorrhage in California

“…For example, substandard care, such as poor between‐provider communication, treatment delays, and ineffective first‐line treatment, is an important contributor of PPH‐related morbidity 8,33 . Deficiencies in system‐wide approaches for PPH prevention and management, including lack of PPH risk assessment or blood loss measurement, communication failures, barriers to accessing uterotonic drugs, and no event debriefing, have also been reported 34–36 …”

“…8,33 Deficiencies in systemwide approaches for PPH prevention and management, including lack of PPH risk assessment or blood loss measurement, communication failures, barriers to accessing uterotonic drugs, and no event debriefing, have also been reported. [34][35][36] Given the challenges and costs of capturing clinical data, specifically quantifiable blood loss, at a populationlevel, administrative data remain an efficient means of assessing hospital-level PPH rates across large patient populations. However, we acknowledge that variation may exist in the accuracy and quality of ICD-9 coding across hospitals which may have contributed to the unaccounted-for variation in hospital-specific PPH rates.…”

Prevention of Failure to Rescue in Obstetric Patients: A Realist Review

“…An overall hospital culture of patient safety was beneficial for the implementation of QI efforts to reduce FTR, whereas a lack of hospital resources impeded improvement efforts (Bingham, Scheich, & Bateman, 2018;DeTina et al, 2019;Seacrist, Bingham, Scheich, & Byfield, 2018;. The Delphi method was recommended to identify local barriers to improvement efforts and to choose bundle components for implementation (DeTina et al, 2019).…”

Impact of measuring quantification of blood loss versus estimation of blood loss during cesarean deliveries

“…Graduated vaginal delivery drapes had an error rate of less than 15% when properly utilized 12 . QBL is recommended as part of the National Partnership for Maternal Safety consensus bundle to mitigate PPH and is regarded to be a high patient impact initiative along with protocol‐driven management, unit‐based simulation drills, team huddles, and debriefings 13,14 …”

“…12 QBL is recommended as part of the National Partnership for Maternal Safety consensus bundle to mitigate PPH and is regarded to be a high patient impact initiative along with protocoldriven management, unit-based simulation drills, team huddles, and debriefings. 13,14 With the advantage of QBL established and an increasing number of labor and delivery teams nationally adopting this method of measuring blood loss to attenuate postpartum hemorrhage, we wanted to understand whether implementation of QBL made a difference in providing earlier recognition and resuscitation during cesarean delivery (CD). The first aim of this study was to evaluate all CDs at an academic medical center and determine whether there is a statistically significant numerical difference between QBL versus EBL.…”