A collaborative approach to achieving a change in practice: implementing quantitative blood loss assessment at Birmingham Women's

A Morgan, Z Riddell, K Cullis

Hospital

Birmingham Women's Hospital

Rationale

The aim of our quality improvement project was to create a streamlined approach to PPH management at our trust. The first of which was to establish quantitative blood loss assessment in theatre rather than estimated blood loss.

It was based on the successes of the OBS Cymru national quality improvement project. (1)

Methods
We took a collaborative approach to ensure staff were empowered and

engaged in an attempt to achieve a sustained change.
We took professional leave for three days, which allowed us to focus

fully on trialling, amending and implementing the new procedure.

Results
There was a significant improvement in accuracy of blood

loss volumes recorded

Following our intervention, all cases now have blood loss recorded either during the case (if heavy intraoperative loss) or after the case (in normal routine procedure).

Discussion

We feel that the success of our quality improvement project in achieving sustained change was down to the early engagement of staff who would be responsible for the ongoing implementation of this new practice.

Observed top down approaches to implentation of new procedures have often failed to gain traction due to lack of engagement of staff on the ground.

Discussion with other local centres implementing OBS Cymru approach to PPH management has found difficulties ensuring sustained practice.

Our experience has been easier than others which we attribute to the collaborative approach we have taken and exemplifies a case study in effective management and team working.

References

(1) OBS Cymru Quality and Safety Sub Group of Maternity Network Wales, Elinore Macgillivray, All Wales Guideline: Prevention and Management of Postpartum Haemorrhage Version 1.5; NHS Wales

Observed current practice.
Collated a list of dry weights of swabs, mops, drapes, used in theatre.
Created a proforma with a list of dry weights and how to record blood loss.

Engaged staff at morning handover.

Set out our objectives and hopes to theatre staff

Sought feedback on the pro forma
Collaborated with staff to ensure sterility maintained whilst weighing swabs.
Demonstrated use of profoma and calculations.

Staff encouraged to weigh swabs and perform calculations Theatre presence from us to assist and hone process. Further changes made

Laminated proformas
Excel based calculator for automatic calculations created

Figure 1: Excel based calculator - used on trust computers and on smartphones

Theatre staff independently weighed swabs.
Presence from our team nearby to assist if required. Introduction of team to inform anaesthetic and obstetric staff if specific blood loss threshold met.