Measuring Our Way to Reducing Severe Maternal Morbidity With Quantification of Blood Loss in the Labor and Delivery Operating Room.

Abstract

Objective: To initiate quantification of blood loss (QBL) for all cesarean births to align with professional obstetric organizations' recommendations and to reduce hemorrhage-related severe maternal morbidity (SMM).

Design: Quality improvement (QI) project.

Setting/local problem: Before December 2022, a large northern California hospital relied on estimating blood loss during childbirth, contrary to recommendations from national obstetric organizations. Estimating blood loss during childbirth has been consistently shown to be inaccurate, leading to recommendations for QBL by organizations such as the Association of Women's Health, Obstetric and Neonatal Nurses, the American College of Obstetricians and Gynecologists, and the California Maternal Quality Care Collaborative. Obstetric hemorrhage is the leading cause of SMM and mortality. Accurate blood loss measurements are necessary for effective hemorrhage management.

Participants: The QI team consisted of two nurse leads and their labor and delivery department's nursing professional development specialist. The labor and delivery department consists of 237 registered nurses and 14 obstetric technicians.

Methods: The QI team used the Plan-Do-Study-Act method to develop a workflow for QBL in cesarean births.

Results: The percentage of cesarean births in which QBL was used increased by more than 83% at 1 year after implementation. The rate of hemorrhage-related SMM in the same period was reduced by 1.8%.

Conclusion: QBL was successfully implemented by staff nurses in the department and sustained within the organization. The effect on SMM cannot be directly tied to the implementation of QBL, but QBL may have affected this metric.