- Modified format to improve usability
- Added parameters for ongoing risk assessment at least at every shift or patient handoff
- Emphasizes oxytocin as the main component and definitively states that active management of third stage labor (AMTSL) should not interfere with delayed cord clamping
- Continues to emphasize oxytocin as first line for prevention and treatment and offers changes in misoprostol dosing recommendations
- Clarifications around blood replacement recommendations
- Substantial expansion on patient and family support and a resource list
- Additional structure, process and outcome measures.
The toolkit is available to download after logging into CMQCC's website.
Download:
Improving Health Care Response to Obstetric Hemorrhage, Version 2.0
Slide Set for Professional Education
Webinar link: OB Hemorrhage Toolkit V2.0 Orientation Webinar
The following individual sections of the toolkit are available to users who have completed the Toolkit survey:
Executive Summary
Emergency Management Plans
Obstetric Hemorrhage Emergency Management Plan: Checklist
Obstetric Hemorrhage Emegency Management Plan: Table Chart
Obstetric Emergency Management Plan: Flow Chart Format
OB Hemorrhage Toolkit Pocket Card
Systems Level Readiness
OB Hemorrhage: Carts, Kits and Trays and Checklist
Simuations & Drills
- Educational Tool #1: Guidelines Simulation Scenario Development
- Educational Tool #2 Sample Scenario #1: Drill for Uterine Atony
- Educational Tool #3: Sample Scenario #2: Drill for Hemorrhage and Pulseless Electrical Activity in the OR
- Educational Tool #4: Kaiser Evaluation for Drills; Debriefing Tool
Patient Level Readiness
Placenta Accreta and Percreta: Incidence, Risk, Diagnosis, Counseling and Preparation for Delivery
Inherited Coagulation Disorders in Pregnancy
Planning for Women (Jehovah's Witnesses and Others) Who May Decline Blood and Blood Products
- Jehovah's Witness Blood Product and Technique Informed Consent/Decline Checklist
- Specific Checklist for Management of Pregnant Women Who Decline Transfusions
- Iron Sucrose Protocol
- Iron Ferric Carboxmaltose Protocol
Recognition
Definition, Early Recognition and Rapid Response Using Triggers
Risk Factor Assessment
Cumulative Quantitative Assessment of Blood Loss
Active Management of Third Stage Labor
Response
Uterotonic Medications for Prevention and Treatment of Postpartum Hemorrhage
Blood Product Replacement: Obstetric Hemorrhage
Uterine Tamponade for Obstetric Hemorrhage: Internal Balloons and External Compression Stitches
Uterine Artery Occlusion and Embolization
Women's Experience of Obstetric Hemorrhage: Informational, Emotional and Physical Health Needs
- Resources for Women, Families, and Clinicians After An Obstetric Emergency
- Discharge Planning for Women with Complications During the Birth Hosptial Stay
Preparedness Considerations for Small and Rural Hospitals
Anti-Shock Garments: Non-Pneumatic Anti-Shock Garment (NASG) and Pneumatic Anti-Shock Garment (PASG)
Reporting Systems
OB Hemorrhage Measures for Hospital QI Projects
Appendices
Appendix A: Stages of Hemorrhage Poster for Cart
Appendix B: Sample Scenario #2 Critical Event Team Training
Appendix C: Debriefing Tool
Appendix D: Samples of Massive Transfusion Protocols (Complete Set)
- Appendix D: Massive Transfusion Protocol
- Appendix D: Massive Transfusion Event Protocol Policy
- Appendix D: Emergency Transfusion of Uncross-matched Blood and Blood Products
- Appendix D: Massive Transfusion Event Protocol Flowchart
Appendix E: NHS Obstetric Early Warning Chart
Appendix F: Techniques for Quantitative Assessment of Blood Loss
Appendix G: A Guide to Recognizing Acute Stress Disorder in Postpartum Women in the Hospital Setting
Appendix H: QBL Calculator Cesarean Section
Appendix I: Two Step Quantification of Blood Loss at Cesarean Birth
Appendix J: QBL Calculator in EMR Delivery Summary