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Improving patient blood management in obstetrics: snapshots of a practice improvement partnership
  1. Cindy J Flores1,
  2. Farah Sethna2,3,
  3. Ben Stephens4,
  4. Ben Saxon5,
  5. Frank S Hong1,
  6. Trish Roberts5,
  7. Tracey Spigiel5,
  8. Maria Burgess4,
  9. Belinda Connors4,
  10. Philip Crispin3,6
  1. 1Australian Red Cross Blood Service, West Melbourne VIC, Australia
  2. 2Obstetrics & Maternal/Fetal Medicine, Canberra Hospital and Health Service, Garran ACT, Australia
  3. 3Australian National University Medical School, Garran ACT, Australia
  4. 4Canberra Hospital and Health Service, Garran ACT, Australia
  5. 5Transfusion Policy and Education, Australian Red Cross Blood Service, Adelaide SA, Australia
  6. 6Haematology, Canberra Hospital and Health Service, Garran ACT, Australia
  1. Correspondence to Cindy Flores, Australian Red Cross Blood Service, 100-154 Batman St, West Melbourne, VIC 3003 Australia; cflores{at}redcrossblood.org.au

Abstract

Iron deficiency and anaemia are common in pregnancy. Audit data from our tertiary obstetrics unit demonstrated 22% of maternity patients experiencing a postpartum haemorrhage received a transfusion; a third of whom were anaemic on admission intrapartum. Australian Patient Blood Management (PBM) Module 5 Obstetrics guidelines focuses on maximising red cell mass at the time of delivery and reducing the reliance on transfusion as a salvage therapy to treat blood loss. A clinical practice improvement partnership began in February 2015 and completed in April 2016; which aimed to implement systems to improve antenatal identification and management of iron deficiency, and improve postpartum anaemia management. In order to develop change strategies, reasons for poor detection and correction of iron deficiency in the antenatal period were identified following a quality improvement methodology. Education was delivered to maternity healthcare providers. Standardised algorithms and an oral iron prescription handout were developed and piloted. Follow-up audit, staff and patient feedback, and other hospital data were collected to measure outcomes. The rate of anaemia on admission intrapartum fell from 12.2% in 2013 to 3.6% in 2016 following the introduction of unselective ferritin screening and other antenatal interventions. Sixty to 70% of maternity patients screened each month had iron deficiency. The algorithms aided staff to become confident in blood test interpretation and management of iron deficiency and anaemia. Patients found the oral iron prescription handout helpful. Additionally, single unit transfusions significantly increased from 35.4% to 50% (p=0.037) over the project timeframe. This project demonstrated the potential to improve patient blood management in obstetrics, reduce anaemia and transfusions by active antenatal interventions.

  • Iron Deficiency
  • Ferritins
  • Blood Transfusion
  • Pregnancy
  • Anaemia

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