Project Mission Statement
- Providing the training and support needed to develop standards of care for preventing, detecting, and treating obstetric bleeding.
- Collaborate with patients and their families to optimize care and support for obstetric bleeding.
- Identification and elimination of differences in health care related to clinical practice.
Project Purpose and Justification
According to the Committee on Obstetric Practice (2019), postpartum hemorrhage is responsible for approximately 11% of maternal deaths in the United States. Thus, this project aims to reduce the incidence of postpartum hemorrhage, so fewer mothers have blood transfusions, severe procedures, or serious medical complications.
High-Level Requirements
- Reducing the incidence of severe PPH and associated maternal diseases, including a decrease in blood product intake, a decrease in maternal ICU admissions, and increased use of preventive and early intervention measures.
- Improving teamwork between midwives and staff.
- Improved identification of high-risk patients.
Assigned Project Manager and Authority Level
The obstetric head will be the leader of this project and will have the power to select team members, determine the timeline for the project, and approve the final budget.
Summary Milestones
November 2021 – Patient Safety Survey.
December 2021 – Project start, first team meeting, formation of subgroups.
January 2022 – Hemorrhage Carts, Data & Modeling Team Meetings, Process Mapping.
February – April 2022 – Pilot introduction of simulators and hemorrhage carts; reviews of schedules and observations of the provider; assessment of modeling of blood loss.
May – July 2022 – Bleeding Cart and Bleeding Simulator fixes and improvements, continued data collection, structured discussions, RCA, and clinical training preparation.
Aug – Oct 2022 – RCA with map review data, structure finalization for simulators/training, vendor observation analysis, clinical education; final report.
Stakeholder Influences
The project’s primary stakeholders are obstetric patients and their families; delivery staff, including doctors, nurses, and midwives; managers and nurses in the postpartum ward; teams of operating rooms and intensive care units; hospital administration; blood bank; anesthesiology. Obstetric staff is responsible for recognizing and treating postpartum hemorrhage on time, collaborating with other clinicians required to care for the woman, right down to senior clinicians for severe PPH. The anesthesiologist staff is responsible for providing and advising on clinical care in cases of severe PPH that require intensive monitoring and resuscitation. The hematologist will agree to deliver blood products and advise on supporting blood transfusion and treating coagulopathy.
Functional Organizations and Their Participation
Almutairi (2021) notes that reducing maternal mortality by 75% is a Sustainable Developmental Goal 5 set by WHO. WHO regularly develops documents and various recommendations for the prevention and treatment of postpartum hemorrhage (for example, WHO recommendations for the prevention and treatment of postpartum hemorrhage (2012) and WHO guidelines for the management of postpartum hemorrhage and retained placenta (2009)). Thus, this information can assist in the development of specific solutions to minimize deaths from postpartum hemorrhage. Moreover, various organizations in many states are committed to ending preventable morbidity and mortality in women, including in obstetric wards (for example, The California Maternal Quality Care Collaborative).
Organizational, Environmental, and External Constraints
- Overcoming potentially profoundly ingrained practices and attitudes of suppliers and employees.
- Limited staff to implement and support the program.
- Blood transfusions are prohibited among some religious groups, including Jehovah’s Witnesses. Their decision is not related to the perceived risk of blood transfusion but represents a biblical position: ‘abstain from the meats offered to idols and from blood’ (King James Bible, Acts 15:29).
Business Case: ROI
Shaz and Hillyer (2018) assert that an obstetric patient’s budget cost per day is $ 3,400. The average LOS for this patient population is two days for $ 6,800. Patients who have had postpartum hemorrhage usually have a longer duration of drugs, requiring additional monitoring to ensure they are resistant to discharge. Based on the average daily cost, a four-day patient stay would cost $ 13,600. Therefore, reducing the incidence of PPH will result in lower LOS for patients and lower costs.
Proposed Project Sponsor
A healthcare organization’s director, manager, and department educator can become project sponsors.
References
Almutairi, W.M. (2021). Literature review: Physiological management for preventing postpartum hemorrhage. Healthcare, 9(6), 658.
Committee on Obstetric Practice. (2019). Quantitative blood loss in obstetric hemorrhage. Obstetrics & Gynecology, 134(6), 150-156.
King James Bible (n.d.). King James Bible Online. Web.
Shaz, B. & Hillyer, C. (2018). Transfusion medicine and hemostasis: Clinical and laboratory aspects. Elsevier Science.