Implementing a Massive Transfusion Protocol in Labor and Delivery

Purpose for the Program: Nurses in the labor and delivery unit at Baylor University Medical Center recognized a need to guide staff during a massive hemorrhage. Postpartum hemorrhages continue to be a leading cause of maternal death in the United States. Staff felt that developing an interdisciplinary protocol and standardized education would help foster timely communication that leads to improved patient outcomes. Proposed Change: To develop an obstetric (OB)‐specific massive transfusion protocol (MTP) by utilizing current evidence‐based practice transfusion recommendations. Our hospital has had a MTP for many years. As a result of working in conjunction with the blood bank and the OB anesthesia unit, we also defined the nurse's roles in caring for patients during massive hemorrhages and transfusions. This tool serves as a guide for nursing staff. By activating this MTP, we ensure that all appropriate parties are aware of the emergent situation. Implementation, Outcomes, and Evaluation: We assessed the knowledge base of our staff before creating our education plan. The results from that the assessment suggested we focus on the definition of massive hemorrhage. Furthermore, the results indicated what labs to anticipate, which resources to utilize, and what the role of the nurse should be during a massive hemorrhage. Education focused on these key components in addition to the new obstetric MTP. To reiterate the components addressed through education and to focus on the nurses’ roles, all nursing staff were required to complete a simulation drill with the focus on massive hemorrhage and implementation of the protocol. The protocol was placed in all the delivery rooms, the operating room (OR), the recovery room, and the hemorrhage cart for quick reference. Implications for Nursing Practice: Having a MTP in place for the labor and delivery staff allows for rapid and organized response in what can be a hectic emergency. Standardizing protocols and clearly defining responsibilities helped to outline steps for the interdisciplinary team to provide optimal treatment and effective communication. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses