1. OB Hemorrhage: A Collaborative Approach to Standardization Presented by: Kristi McClure, RN, MSN, C-EFM Clinical Educator, MCW June 26, 2014

2. Mount Carmel Health System *

3. MCHS OB Collaborative

4. The Collaborative Approach Who –Multidisciplinary team –Physician champions

5. The Standardization Process What –The equipment –The process –The team –The documentation

6. The Standardization Process Where –Hospital –Health System –Region/State –Nation

7. But WHY? Aviation ACOG AWHONN

8. How do We Start? (Project Planning) Regular monthly meetings Leadership buy-in Budget planning Timeline/scheduling Physician Engagement

9. Project Components Education Program OB Hemorrhage policy Rapid Response Team Massive Transfusion Protocol Written review process (Peer Review) Written process for weighing blood soaked items when hemorrhage identified

10. Accomplishments

11. Equipment - OB Hemorrhage Cart

12. Policy Development Policy written to include: –Risk assessment of all patients –Weighing all materials for accurate EBL –Staging of hemorrhage based on EBL –Reference to Massive Transfusion Policy*

13. OB Alert

15. Trinity OB Hemorrhage Education Plan Education RequirementsResponsible PersonsTime Requirement per Participant Approx. Number of MCSA Participants HealthStream Online Pre-Test (Nov 1, 2013 – Mar 31, 2014) Required: Nurses (L&D, MIU, RRT) Physicians (Residents, Employed, Independent) CNMs Encouraged: Anesthesia Providers 30 minutes Nurses = 190 Physicians = 113 CNMs = 15 Anesthesia = 21 Recommended Readings & HealthStream Online Didactic Lecture (Nov 1, 2013 – Mar 31, 2014) Required: Nurses (L&D, MIU, RRT) Physicians (Residents, Employed, Independent) CNMs Encouraged: Anesthesia Providers 90 minutes Nurses = 190 Physicians = 113 CNMs = 15 Anesthesia = 21 OB Hemorrhage Skill Stations (Apr 30, 2014 – Sept 30, 2015) Required: Nurses (L&D, MIU, RRT) Physicians (Residents, Employed, Independent) CNMs OBT, MST, PCA Encouraged: Anesthesia Providers 30 minutes Nurses = 190 Physicians = 113 CNMs = 15 Anesthesia = 21 OBT, MST, PCA = 38 HealthStream Online TeamSTEPPS Lesson (Apr 30, 2014 - Sept 30, 2015) (Must be completed before simulation) Required: Nurses (L&D, MIU, RRT) Physicians (Residents, Employed, Independent) CNMs OBT, MST, PCA Unit Coordinators Encouraged: Anesthesia Providers 30 minutes Nurses = 190 Physicians = 113 CNMs = 15 Anesthesia = 21 OBT, MST, PCA = 38 Unit Coordinators = 17 Simulation & Debriefing (Apr 30, 2014 – Sept 30, 2015) Required: Nurses (L&D, MIU, RRT) Physicians (Residents, Employed, Independent) CNMs OBT, MST, PCA Unit Coordinators Encouraged: Anesthesia Providers 90 minutes Nurses = 190 Physicians = 113 CNMs = 15 Anesthesia = 21 OBT, MST, PCA = 38 Unit Coordinators = 17 HealthStream Online Post-test (complete 3-6 month after simulation/debriefing– no later than Mar 31, 2016) – Must achieve a score of 80% Required: Nurses (L&D, MIU, RRT) Physicians (Residents, Employed, Independent) CNMs Encouraged: Anesthesia Providers 30 minutes Nurses = 190 Physicians = 113 CNMs = 15 Anesthesia = 21 TOTALS5 hrs over 2 ½ years Total Time: 1,824 hrs over 2 ½ years 339 377 394 339

16. Skills Stations

17. Simulation

18. Documentation

20. Ultimate Goal