SE2EOa

 

Professional Organization SE2EO

 

Using the required empirical outcomes (EO) presentation format, provide one example of an improved patient outcome associated with an evidence-based change in nursing practice that occurred due to a clinical nurse’s(s’) affiliation with a professional organization. 

 

 

Example a: Improving Postpartum Care

Problem

Estimated blood loss (EBL) was not giving Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) Labor, Delivery, Recovery, and Postpartum (LDRP) nurses the information needed to intervene for a patient having a postpartum hemorrhage (PPH). The interventions needed to be timely, so the rate of blood loss did not get to the point of needing a blood transfusion, which is a problem experienced by the CHI SVHS LDRP in May 2023.

 

Pre-Intervention

Kaci Mills, BSN, RN, CPN, Clinical Nurse, LDRP, a member of the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN), noted in May 2023 an increased trend of postpartum patients who were receiving blood transfusions related to PPHs. The LDRP rate of PPHs that required blood transfusions was 2.27. This rate was calculated by taking the number of patients requiring treatment (transfusion), divided by the total number of patients who delivered, multiplied by 100.

 

Mills, an LDRP Unit-Based Council (UBC) member, reviewed evidence-based guidelines on PPHs, specifically through AWHONN journals. While reviewing AWHONN articles, Mills noted these key details:

  • PPH remains a leading cause of maternal mortality in the United States.
  • Additionally, inaccurate evaluation of blood loss can lead to delays in response and management of PPH.
  • Quantification of blood loss (QBL) helps to increase the timely escalation of clinical care influencing outcomes.

 

Mills also reviewed an article through the American College of Obstetricians and Gynecologists (ACOG), which concluded that the implementation of obstetric hemorrhage bundles that include QBL significantly reduces maternal morbidity. Delays in recognition and management result in costly treatment for women having PPHs.

 

Goal Statement

Decrease the rate of CHI SVHS LDRP PPH patients that require a blood transfusion.

 

Participants

 

 

Postpartum Hemorrhage Workgroup

 

Name/Credentials

Discipline

Title/Role

Department

Amy Gates, BSN,
RN

Nursing

Nurse Manager

LDRP, Pregnancy
Clinic

Kaci Mills, BSN, RN, CPN

Nursing

Clinical Nurse

LDRP

Brock Warford, MD

Physician

MD

LDRP, Pregnancy Clinic

 

Description of the Intervention

June 2023

  • A list of needed supplies was given to Amy Gates, BSN, RN, LDRP Nurse Manager. The list of supplies was derived from the ACOG article, Quantitative blood loss in obstetric hemorrhage: ACOG committee opinions no. 792. Obstetric & Gynecology, 134[6], e150-e156.) Box 1 Tips for Quantification of Blood Loss (QBL). Having these supplies readily available in each laboring suite would allow nurses to start QBL without any interruptions or leaving the room. This, in turn, would allow for a quicker response from the physicians if needed, due to being in the room once QBL started. Supplies were ordered in July 2023, including:
    • Scales in each delivery suite
    • Disposable bed pads
    • QBL under buttocks drapes

 

July 2023

  • Twelve scales, three cases of disposable bed pads, and three cases of QBL under buttocks drapes were ordered. The disposable bed pads and QBL drapes were set up on an automatic monthly reorder. Scales would be cleaned after each use.
  • QBL began July to September quarterly education and drills reviewed in the LDRP unit meeting.

 

 

August 2023

  • All LDRP nurses needed to complete mandatory PPH Elsevier online education each quarter.
  • Mills developed materials to conduct PPH drills. References for these drills included the example obstetric hemorrhage checklist-SC DHHS. (n.d.)., Elsevier, Acute postpartum hemorrhage-statpearls- NCBI bookshelf. (n.d.-a). and Preparing for clinical emergencies in obstetric and gynecology. ACOG. (n.d).
  • The drill included the early signs and symptoms of PPH, nursing interventions, medications to administer, and Bakri balloon.
    • Drill pre- and post-test
    • Evaluation
  • Mills developed an education trifold board and placed them at the nurses’ station for two weeks. The contents of the board included:
    • Statistic: “54% to 93% of maternal deaths due to obstetric hemorrhage may be preventable” ACOG
    • What will change? New items coming soon
    • Screenshot of EPIC QBL flowsheet
    • Picture of QBL drape
    • EBL vs. QBL: What’s the difference?
    • Tips for QBL during vaginal delivery
    • Tips for QBL during Cesarean births

 

September 2023

  • Received scales, bed pads, and QBL drapes, and scales were placed in each labor suite, while bed pads and QBL drapes were placed in the central supply room. These items were gathered when setting up the delivery table.
  • Mills completed PPH first quarterly drills on both day and night shifts.
  • The education board was moved into the breakroom for quick reference when needed and for the education of new coworkers.
  • QBL quarterly education and drills were reviewed in the LDRP unit meeting.

 

The interventions were fully implemented by the end of September 2023.

 

An evidence-based change in nursing practice to QBL instead of EBL occurred, due to Mills’ affiliation with AWHONN. This change was associated with an improvement in the rate of PPHs requiring blood transfusion.

 

References

Gams, B., & Manning, W. (2021). Quantification of blood loss: Awhonn Practice Brief Number 13. Nursing for Women’s Health, 25(4). https://doi.org/10.1016/j.nwh.2021.04.005

 

Mishra, N., Dhruw, S., Mishra, I., & Daharwal, A. (2020). Visual estimation of blood loss versus quantification of blood loss after vaginal birth using an innovative drape: A prospective study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(1), 268. https://doi.org/10.18203/2320-1770.ijrcog20205780

 

Smith, C., Borders, A., & King, T. (2019). Quantitative blood loss in obstetric hemorrhage. Obstetrics & Gynecology, 134(6). https://doi.org/10.1097/aog.0000000000003564

 

Outcome

(Evidence SE2EOa-1, Postpartum Hemorrhages Requiring Transfusion Graph)