1. Obstetric Hemorrhage Measures Outcome Process Structural (“deliverables”) Data Quality California Partnership for Maternal Safety Patient Safety First (HQI)

2. OB Hemorrhage Measures Outcome 1.Number of women transfused ≥ 4 units RBCs (per 1,000 mothers giving birth) 2.Total number of blood products transfused 3.Severe maternal morbidity per 100 women with obstetric hemorrhage 4.Maternal deaths from hemorrhage (to be calculated for the entire population, not individual hospital) per 10,000 women giving birth 1.Count of completed hemorrhage debrief forms for those patients who meet criteria (stage 2, 1000 ml, 2 nd dose of secondary uterotonic, tamponade balloon, B-lynch suture). Ideally, 5 per month. Process

3. OB Hemorrhage Measures 1.Accuracy of ICD9 codes for RBC transfusion (Under coding: How many cases that got transfused per Blood Bank data had ICD9 coding for transfusion?) 2.Accuracy of ICD9 coding for Hemorrhage (Under coding: How many women who had a transfusion code also had a hemorrhage code) Structure Data Quality

4. OB Hemorrhage Metrics: Data Sources Outcome Blood Bank data: raw counts of: total RBC units, total FFP units, total mothers transfused, total mothers with 4 or more RBCs ICD9 codes for all OB patients Process1 process measure requiring NO CHART REVIEW, only a count of debriefs done Structure13 Structural measures to check off once, requiring a date sign off when complete Data Quality 2 measures derived from Blood Bank and ICD9 data submitted for outcome measures above

5. Importance of Partnering with the Blood Bank  A good relationship with the Blood Bank is a key to successful implementation of the safety bundle and safe care of hemorrhage patients  Several of the bundle steps require the Blood bank  Blood Bank is the best source of transfusion data and they need to do QI projects—many have been thrilled to do something new!  The Joint Commission has announced that as of Jan 1, 2015, RBC transfusion of ≥4 units for an OB patient will be a Sentinel Event, so the Blood Bank will be involved with capturing those events