FPQC’s Obstetric Hemorrhage Initiative (OHI) Launched



Yelverton Boyer and AttendeeOn October 30, 2013, over 100 individuals from 31 Florida hospitals and 4 North Carolina hospitals met at Winter Park Memorial Hospital to begin an 18 month initiative designed to reduce the incidence and severity of obstetric hemorrhage. Attendees from the hospitals participating in the OHI came in teams of nurses, physicians and administrators.

The initiative is a product of the collaboration of providers and hospitals across the state with participation and leadership from the following groups:  ACOG District XII, AWHONN, ACNM, Florida Hospital Association, and March of Dimes, in conjunction with the Florida Perinatal Quality Collaborative.  This partnership has used evidence-based practices to develop an implementation toolkit and related resource materials that local hospitals will utilize as guides in the initiative.

Robert Yelverton, MD, ACOG District XII Chair, presented information on the incidence of obstetric hemorrhage in Florida and the United States, with hemorrhage being a leading cause of severe morbidity and mortality related to pregnancy.

The inaugural presentation of the Florida Obstetric Hemorrhage Initiative Toolkit was given by Anthony Gregg, MD, ACOG District XII Chair of the Maternal Mortality Committee. Hospitals reviewed and discussed the key components of hospital implementation for the OHI, including specific hemorrhage management policies with standardized definitions and responses, a massive transfusion protocol, antepartum risk assessment, active management of the third stage of labor, cumulative quantification of blood loss, interdisciplinary simulation drills and debrief sessions, and ensuring availability of medications and equipment.Simulation_6

Participants practiced recognition and response to hemorrhage in a simulated drill led by Judette Louis, MD. Teams were encouraged to adopt a multidisciplinary approach designed to improve early recognition, response, and outcomes.

Margie Mueller Boyer, RNC, MS, Florida Section Chair of AWHONN, led a presentation on estimated vs. quantification of blood loss using several techniques.  Participants were quizzed on their skill at recognizing blood loss quantity and began planning activities for local implementation.

Of the participating hospitals, initial application data indicates that 33% did not have written obstetric hemorrhage management policies in place prior to the launch, but all have access to recommended equipment and medications, and the majority feel well prepared to respond to implement the initiative and respond to hemorrhage.

Evaluation of the meeting by the participants indicated that key objectives were met, that new skills were acquired, and additional needs were identified to be addressed in upcoming monthly webinars and technical assistance activities.

Both process and outcome measures will be used to track progress and evaluate the initiative.  Data will be aggregated across the hospitals with a goal of decreasing massive hemorrhages by 50% by December 2014.

Presentations stimulated energetic discussions among the OHI clinical leads and the hospital teams. Participants learned a great deal from one another as they shared the practices that have been implemented at other hospitals and the barriers and challenges many have experienced.

More information on the OHI: http://health.usf.edu/publichealth/chiles/fpqc/ohi

Written By: Emily A. Dunn, MA, MPH