Improving the management of obstetric hemorrhage with the use of quantified blood loss

Background: Obstetric hemorrhage is one of the leading causes of maternal morbidity and mortality, yet it is highly preventable. Blood loss is frequently underestimated, delaying treatments and interventions. Using an objective quantification of blood loss (QBL) helps recognize and treat hemorrhage earlier. This may reduce morbidity and mortality caused by Obstetric Hemorrhage, especially among racial and ethnic minorities who experience a 26.6% higher incidence. Blood loss should be quantified using an objective standardized instrument to avoid subjective human error and implicit bias. Local Problem: Estimated blood loss was routinely used in our Obstetric unit whose population is largely women of color. A need to implement an objective method of evaluating blood loss was identified. Method: We implemented the strategies recommended by the Illinois Perinatal Quality Collaborative (ILPQC) to improve the use of QBL. The care team was educated on proper weighing techniques and documentation. QBL was one of the components of the mandatory Obstetric Hemorrhage simulations. We improved our readiness for using QBL by purchasing scales, revision of our dry weight chart, and insured the hemorrhage cart was stocked and available for use. Audits were completed to evaluate improvement. Results/Conclusions: 100% of the care team were educated on QBL. To determine our compliance rate of using quantified blood loss versus estimated blood loss, chart audits were conducted. In February 2022 our baseline use of QBL exclusively was 0%. This rate improved to 70% by January 2023. Implications for Practice: The strategies implemented at our hospital have improved the use of QBL and should improve patient outcomes in management of obstetric hemorrhage. Education and auditing will be ongoing to ensure the change in culture is maintained. Further surveillance will be needed to demonstrate the effectiveness of QBL on clinical outcomes and reduction of maternal morbidity and mortality in cases of Obstetric Hemorrhage