Patient Safety and Quality

  • 1.  Operationalizing Joint Commission post-delivery hemorrhage assessment

    Posted 10-21-2020 13:11
    Hi all -

    I'm curious how you are planning to operationalize the "on admission to postpartum" component of the Joint Commission guidance, "Complete an assessment using an evidence-based tool for determining maternal hemorrhage risk on admission to labor and delivery and on admission to postpartum." What evidence-based tools have you identified, and how are you using them ?

    -Alison


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    Alison Stuebe
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  • 2.  RE: Operationalizing Joint Commission post-delivery hemorrhage assessment

    Posted 10-22-2020 09:28
    I practice at an HCA hospital.

    The OB nurses do their charting in a software program called CPN.
    There is a mini-worksheet in CPN for hemorrhage risk assessment that is similar to the CMQCC worksheet (with some homegrown modifications).  The worksheet stratifies PPH risk as low, med, high.  We order T&S on all L&D admissions.  If high risk, we order 2 units on hold.  

    There is a second worksheet that contains updates for events in labor.

    Our targets are to have initial risk assessment within 2 hours after admission, updated assessment within 1 hr before delivery, and updated assessment within 1 hr of transfer to postpartum unit.  Our completion rates for those 3 timepoints are 70-80%, 30-50%, and 80-90%, respectively.  We have a QI project starting to work on the second timepoint.  In answer to your specific question about operationalizing re-assessment upon transfer to postpartum, yes, we do that, and that's where we have the highest completion rate!

    Andy

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    C. Andrew Combs
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  • 3.  RE: Operationalizing Joint Commission post-delivery hemorrhage assessment

    Posted 10-24-2020 12:50

    We have built a  hemorrhage assessment in the admission note navigator in Epic based on the AWOHNN risk assessment system.  It adds a green, yellow or red dot on the Epic Whiteboard hanging at the Nurses station in a  column for hemorrhage risk  (so we know who has not had a risk assessment  completed).   We also have a BPA tied to this.  It looks to see whether there is a type and screen in the blood bank or whether the patient is type and crossed (based on the level of risk).  If not done, the BPA prompts the provider for the order.

     

    We haven't figured out  the best way to do  this  after delivery.

     

    Peter

     

    Peter S. Bernstein, MD, MPH
    Director, Division of Maternal Fetal Medicine
    Professor of Obstetrics & Gynecology and Women's Health
    Montefiore Medical Center/Albert Einstein College of Medicine
    Jack D. Weiler Hospital
    1825 Eastchester Road
    Bronx, NY 10461 USA
     
    Telephone: 718-904-2767
    Facsimile: 718-904-2799
    Email:     pbernste@montefiore.org
     
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    Original Message