Implementing quantitative blood loss for cesarean section deliveries in a critical access hospital: a quality improvement project

Abstract

Background: The American College of Gynecologists (ACOG) and the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) strongly advocate the adoption of quantitative blood loss (QBL) measurement for all deliveries, as opposed to relying on traditional estimated blood loss reporting. This shift is crucial for the accurate detection of postpartum hemorrhage. In the United States, maternal morbidity due to maternal hemorrhage averages 11%, with up to 93% of postpartum hemorrhages being preventable. Objective: To enhance the awareness and recognition of postpartum hemorrhage during cesarean section deliveries (CSDs) among Operating Room (OR) Registered Nurses (RNs) thereby enabling early identification and intervention in a rural Montana critical-access hospital. Methods: Four electronic databases -- CatSearch, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, and Web of Science were accessed to retrieve peer-reviewed studies addressing the support and/or challenge of incorporating a quantitative blood loss program in an operative setting. All included studies were published between 2017 and 2023. After screening articles, 13 were eligible for inclusion. Results: To evaluate the feasibility and effectiveness of the project, a prospective 5-week Plan-Do-Study-Act (PDSA) cycle was implemented. Quantitative blood loss for all CSDs was assessed and documented. Additionally, EBL data was collected for comparison purposes. Using the QBL method, one CSD was identified as a PPH. Conclusions: The quality improvement project improved OR staff confidence in QBL assessment during CSDs. Consistent QBL application will further enhance accuracy and promptness in identifying and managing PPH, ensuring improved maternal outcomes guided by evidence-based practice recommendations. Implications for Practice: QBL precision enables healthcare providers to promptly identify a PPH and initiate timely interventions to mitigate adverse outcomes. By integrating QBL into CSD workflows, healthcare facilities can enhance patient safety, particularly in rural settings where access and resources may be limited. Overall, implementing QBL monitoring for CSDs represents a proactive approach to enhancing clinical practice, optimizing patient care, and reducing the burden of maternal morbidity and mortality.