Becker's Clinical Quality & Infection Control

21 Executive Briefing To reduce postpartum hemorrhages, The University of Texas Medical Branch's Labor and Delivery team has developed a comprehensive portfolio of tools and processes, including frequent postpartum hemorrhage emergency drills with the labor and delivery team. Risk assessments are integrated into the Epic system and visual aids are posted outside the rooms of patients at risk. When these patients are ready to deliver, the team places the postpartum hemorrhage cart nearby. If there is a postpartum hemorrhage, tranexamic acid and initiation of the massive transfusion protocol is available. How to bring the best tools to the bedside Healthcare leaders with limited resources recognize partnerships with staff are the key to deploying the best tools at the patient bedside. "In situations like quantitative blood loss estimation, I want to hear from the staff," Ms. Minard said. "I want them to try different products and to tell me which one will work best and meet the needs of our department. They are the end users and the feedback they give me is critically important. Shared governance with the staff and letting them make the decisions that control their practice will guarantee success every time for the patient." Dr. Mordecai echoed those sentiments. "Employees have a multiplicity of support," she said. "We work from our end to facilitate and give them the right equipment. But the way the team implements it and puts it together is up to them. Part of the success is not only having the resources, but how the team uses those resources, their attention to detail and their focus on the patient, quality and safety." Collaborative programs create best practices The TexasAIM initiative is an example of a collaborative program created by the Department of State Health Services, the Alliance for Innovation on Maternal Health (AIM) and the Texas Hospital Association. Its goal is to help hospitals and clinics carry out maternal safety projects to end preventable maternal death and severe maternal morbidity. Hospitals and communities nationwide participate in the AIM program and use its maternal safety bundles to improve patient well-being. AIM partners with state teams and health systems to achieve its objectives. The University of Texas Medical Branch partnered with TexasAIM in the postpartum hemorrhage bundle. TexasAIM launched this project in 2018, with a mission to reduce maternal morbidity and mortality across the state. The program has run side by side with The Joint Commission requirements on postpartum hemorrhage. The University of Texas Medical Branch team submitted data quarterly over the past two years, reflecting multiple quality projects implemented while working with different patient teams. "If you want to move forward and try new things, you need physicians, nurses and leadership to be on the same page," Dr. Mordecai said. "They need to be open to new ideas and collaborative processes. You might go into a project thinking that it will make a difference, but sometimes it doesn't. The key is to be open to learning that your hypothesis isn't correct, then adjusting and seeing where you need to go from there." The University of Texas Medical Branch team has found it very helpful to have collaborators from outside the hospital. Through the AIM process, the group has learned about other hospitals' quantitative blood loss initiatives, including how they started, what they implemented and the lessons they learned. Conclusion Health systems continue to pursue new and better ways to quantify blood loss estimation. "After our emergency center study, our unit practice council gathered education for new graduate nurses on estimating blood loss. I think we've gotten better in healthcare, but I definitely don't think we're where we want to be," said Ms. Minard. Better techniques for quantifying blood loss will benefit patients across the board. "Not only are women at great risk during pregnancy, childbirth and postpartum, but racial disparities have come even more to light in the past year," Dr. Mordecai said. "Women of color have higher rates of material complications that result in sickness and death. This work is designed to help all women. The hope is that we can increase safety for women across the nation during childbirth and beyond." n Stryker is one of the world's leading medical technology companies and, together with our customers, is driven to make healthcare better. We offer innovative products and services in Orthopaedics, Medical and Surgical, and Neurotechnology and Spine that help improve patient and hospital outcomes. 1 "Validation of a New Method to Assess Estimated Blood Loss in the Obstetric Population Undergoing Cesarean Delivery," by Fawzi Saoud et al., 2019, American Journal of Obstetrics & Gynecology, Vol. 221 (3), p. 267.E1-267.E6.

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