Massive hemorrhage protocol activation in obstetrics: a 5-year quality performance review

•Seventeen massive haemorrhage protocol events among 19 790 deliveries (0.09%).•Areas of improvement were consistent laboratory testing and hypothermia monitoring.•Over-transfusion occurred more often than under-transfusion.•The majority of hemorrhages were due to uterine atony and abnormal placenta...

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Bibliographic Details
Published in:International journal of obstetric anesthesia 2019-05, Vol.38, p.37-45
Main Authors: Margarido, C., Ferns, J., Chin, V., Ribeiro, T., Nascimento, B., Barrett, J., Herer, E., Halpern, S., Andrews, L., Ballatyne, G., Chapmam, M., Gomes, J., Callum, J.
Format: Article
Language:English
Subjects:
Adult
Blood transfusion
Blood Transfusion - methods
Clinical Protocols
Delivery, Obstetric
Female
Guideline Adherence - statistics & numerical data
Humans
Massive hemorrhage protocol
Massive transfusion protocol
Obstetric Labor Complications - diagnosis
Obstetric Labor Complications - therapy
Postpartum hemorrhage
Postpartum Hemorrhage - diagnosis
Postpartum Hemorrhage - therapy
Pregnancy
Quality Control
Quality improvement
Quality Indicators, Health Care - statistics & numerical data
Retrospective Studies
Young Adult
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Summary:•Seventeen massive haemorrhage protocol events among 19 790 deliveries (0.09%).•Areas of improvement were consistent laboratory testing and hypothermia monitoring.•Over-transfusion occurred more often than under-transfusion.•The majority of hemorrhages were due to uterine atony and abnormal placentation.•In many cases there was no documentation of a debrief after protocol termination. A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team. A multidisciplinary team set the institutional quality indicators for the massive hemorrhage protocol review. A retrospective review of all obstetrical massive hemorrhage protocol activation events from September 2010 to January 2015 was performed. All protocol events occurred before the creation of the quality indicators. Data were retrieved from patient records. There were 17 (0.09%) protocol activations for 19 790 deliveries during the study period. All 17 (100%) patients received at least one unit of red blood cells. Overactivation, defined as the transfusion of
ISSN:0959-289X
1532-3374
DOI:10.1016/j.ijoa.2018.10.004