Clinical Issues

Post-Partum Hemorrhage

Challenge:

One OB team used insights from a second year MORE^OB workshop to conclude that the disbursement of equipment for Post-Partum Hemorrhage (PPH) was making it challenging to effectively respond to emergencies. Given that a swift response time would be required for an emergency of that nature, a swift solution was needed.

Solution:

Through the MORE^OB workshop, the interdisciplinary team considered a range of solutions and eventually proposed using a cart to centralize emergency equipment and mobilize it. Development of the cart involved the interprofessional collaboration of Nursing, Obstetricians, Family Physicians and Respiratory Therapists, ensuring all equipment required for maximum efficiency would be included.

Results:

Greater Efficiency:

The cart saves time and reduces instances of panic for emergency staff by ensuring they have access to all of the equipment they need without having to search for it.

Multiple Benefits:

The cart was improved to include additional equipment in other drawers, granting the ability to respond to various emergencies in addition to PPH, such as seizures.

Shift in Culture:

The multidisciplinary members of front line staff who were involved in the cart’s development succeeded in shifting the thinking in emergencies. What was once a time of panic during an emergency, like a PPH, has now brought practitioners together, knowing all the equipment and MORE^OB algorithms are present to assist in any situation that may arise.

C-sections

Challenge:

One OB team in a fast-growing community recognized that the influx of new babies was resulting in an increase in C-sections and that this trend would continue unless measures were taken to reduce the number of procedures. In fact, C-sections from 25% in 2005 to 29.6% in 2010, higher than the Canadian average

Solution:

In 2010, the MORE^OB Core Team created a specific Cesarean Reduction Strategies Task Force to examine the reasons for these trends and to identify, implement and evaluate a range of evidence-based interventions, with a long-term goal of reducing C-section rates by 5%.

Results:

Large reduction is C-sections:

The team surpassed its original goal of reducing the CS rate to 25%.

Ongoing tracking:

Measurability is built into everyday practice with rates and indicators tracked and reported monthly; when induction and CS rates fall above the goal two months in a row, the team looks for counter-measures to return to goal.

Collaborative problem solving:

The MORE^OB Core Team became attuned to working collaboratively on issues, embracing best practice and evolved problem solving and this approach spread outward to all staff.