National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage

Main, Elliott K.; Goffman, Dena; Scavone, Barbara M.; Low, Lisa Kane; Bingham, Debra; Fontaine, Patricia; Gorlin, Jed B.; Lagrew, David C.; Levy, Barbara

doi:10.1111/1552-6909.12723

Cited by 62 publications

(56 citation statements)

References 45 publications

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“…Other guidelines for peripartum bleeding do not address the issue of optimising haemoglobin during pregnancy, which indicates there is variability of clinical practice in preparing pregnant women for a known haemostatic challenge with a significant risk of transfusion. 13 …”

Section: Introductionmentioning

confidence: 99%

Improving patient blood management in obstetrics: snapshots of a practice improvement partnership

Flores

Sethna

Stephens

et al. 2017

BMJ Qual Improv Report

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Iron deficiency and anaemia are common in pregnancy. Audit data from our tertiary obstetrics unit demonstrated 22% of maternity patients experiencing a postpartum haemorrhage received a transfusion; a third of whom were anaemic on admission intrapartum. Australian Patient Blood Management (PBM) Module 5 Obstetrics guidelines focuses on maximising red cell mass at the time of delivery and reducing the reliance on transfusion as a salvage therapy to treat blood loss. A clinical practice improvement partnership began in February 2015 and completed in April 2016; which aimed to implement systems to improve antenatal identification and management of iron deficiency, and improve postpartum anaemia management. In order to develop change strategies, reasons for poor detection and correction of iron deficiency in the antenatal period were identified following a quality improvement methodology. Education was delivered to maternity healthcare providers. Standardised algorithms and an oral iron prescription handout were developed and piloted. Follow-up audit, staff and patient feedback, and other hospital data were collected to measure outcomes. The rate of anaemia on admission intrapartum fell from 12.2% in 2013 to 3.6% in 2016 following the introduction of unselective ferritin screening and other antenatal interventions. Sixty to 70% of maternity patients screened each month had iron deficiency. The algorithms aided staff to become confident in blood test interpretation and management of iron deficiency and anaemia. Patients found the oral iron prescription handout helpful. Additionally, single unit transfusions significantly increased from 35.4% to 50% (p=0.037) over the project timeframe. This project demonstrated the potential to improve patient blood management in obstetrics, reduce anaemia and transfusions by active antenatal interventions.

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Section: Introductionmentioning

confidence: 99%

Improving patient blood management in obstetrics: snapshots of a practice improvement partnership

Flores

Sethna

Stephens

et al. 2017

BMJ Qual Improv Report

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“…The goal of the NPMS is the adoption of the safety bundle by every birthing facility in the United States. A patient safety bundle is a set of straightforward, evidence‐based recommendations for practice and care processes known to improve outcomes . As with other bundles the NPMS has developed, the thromboembolism bundle is not a new guideline but rather represents a selection of existing guidelines and recommendations in a form that aids implementation and consistency of practice that is appropriate for the individual birthing facility.…”

Section: Introductionmentioning

confidence: 99%

National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism

D’Alton¹,

Friedman²,

Smiley³

et al. 2016

J Midwife Womens Health

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Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into 4 domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.

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“…This multidisciplinary approach is strongly recommended by the American College of Obstetrics and Gynecology . Such standardized, multidisciplinary approaches have demonstrated reductions in morbidity . These multidisciplinary meetings occur with varying frequency at our institution with a mean of one meeting a month since January 2014; one to two patients are discussed at each meeting.…”

Section: The Role Of the Blood Bankmentioning

confidence: 99%

How do we manage blood product support in the massively hemorrhaging obstetric patient?

O’Brien

Uhl

2016

Transfusion

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Obstetric hemorrhage remains a leading cause of maternal mortality with more than 140,000 deaths annually worldwide. Abnormal placentation has increased to become the most common diagnosis requiring massive blood transfusion in obstetrics, with uterine atony a close second. At our institution, as well as nationwide, there has been a steady increase in pregnancies complicated by abnormal placentation, including accreta, increta, and percreta. Providers at our facility created the New England Center for Placental Disorders in May 2015 to address these complex patients. The incidence of accreta has actually increased 10-fold over the past 50 years, becoming the most common reason for cesarean hysterectomy in highly industrialized countries. The most common risk factor for accreta is repeat cesarean sections, particularly those with associated placenta previa. Contemporary cesarean section rates have risen, with more than 1.2 million women having had a cesarean section in the United States in 2014. We present a case vignette of a multiparous woman presenting with heavy vaginal bleeding at 30 weeks' gestation with imaging concerning for placenta accreta and possible percreta. We describe our approach to the management of these complicated patients.

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National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage

Cited by 62 publications

References 45 publications

Improving patient blood management in obstetrics: snapshots of a practice improvement partnership

Improving patient blood management in obstetrics: snapshots of a practice improvement partnership

National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism

How do we manage blood product support in the massively hemorrhaging obstetric patient?

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