2.50
Hdl Handle:
http://hdl.handle.net/10755/203178
Type:
Presentation
Title:
Code White: A Planned Response to Maternal Hemorrhage in a Community Hospital
Abstract:
(Summer Institute) Maternal hemorrhage is an emergent situation every maternity unit faces on a regular basis. With the advent of Pyxis and the locking of our emergency medications we faced a potentially dangerous situation. We formed a multidisciplinary team to develop a safe 'Code White Cart’ and protocol that would satisfy Joint Commission requirements, while keeping needed drugs and equipment easily accessible, then drilled staff to assure that everyone was comfortable with use of the code white cart and protocols. Through planning and drills, rare, emergent situations can be handled more safely and efficiently. Problem: Pharmacy discovered many nurses removed post-partum hemorrhage medications more often than patients experienced increased bleeding. Nurses stated concern they would not be able to access these medications in a timely manner with them locked in PYXIS. We know that women regularly have post-partum hemorrhages. We know that these hemorrhages can be very significant, and timely intervention is key to the woman's well-being. We knew that timely access to medications had been compromised by PYXIS, leading nursing staff to find "work-arounds" that would not be acceptable to Joint Commission requirements. Strategy: We decided to form a collaborative with the Quality Improvement Department, Risk Management, pharmacy, staff and leadership from Maternity, one of our obstetricians, and blood bank to address the issues and work toward a solution. Practice Change: Multiple practice changes have grown out of this initiative: (1) Creation of the multidisciplinary team; (2) All nurses have a working password on all PYXIS machines on the floor; (3) Testing of every nurses' competency in removing hemorrhage meds quickly; (4) Pharmacy monitoring of all pyxis cubbies for ease of opening, which included limiting the number of meds in each drawer; (5) Drilling w/staff and physicians to hard-wire skills; (6) Purchase and stocking of a 'Code White Cart' similar to the Cardiac Arrest carts in the hospital with all needed equipment and all non-refrigerated meds for easiest access; (6) Creation of a Code white flow sheet summary and policy and training of all staff and providers, as well as members of the Rapid Response Team and Nursing Management hospital-wide; (7) Policy for refill of cart; (8) On-going drills to maintain competency. Evaluation: -videotaping of drills indicated response time for maternal hemorrhage went from 18 minutes, to 3 minutes. We have also had a significant decrease in medications removed and stored outside of PYXIS "in case of" hemorrhage, as staff have become more comfortable that access will be available if needed. Results: See above. Recommendations: We have added the Bakri Postpartum Hemorrhage Balloon to our cart. We strongly believe in the necessity for regular drills to maintain comfort at our institution, and have also presented the information to the Rapid Response Team and Nursing Management Council. Lessons Learned: Nurses will do what they need to do to keep their patients safe. If you want them to follow the rules (etc. not going to 'inventory all meds' to get their postpartum hemorrhage medications, instead of waiting for pharmacy to 'release them' in the midst of a hemorrhage…) then you need a system that works for everyone, not just rules! Bibliography: ACOG Practice Bulletin. Post Partum Hemorrhage, Number 76, October 2006. 108(4), October 2006: pp. 1039-47. Anderson, J.M., Etches, D. (2007). Prevention and Management of Postpartum Hemorrhage. American Family Physician. 75(6). March 15, 2007. pp. 875-82. California Maternal Quality Care Collaborative. CMQCC Obstetric Hemorrhage Toolkit, Guidelines and Compendium of Best Practices. 1/6/10. pp. 1-17. www.CMQCC.org [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]
Keywords:
Maternal Hemorrhage; Community Hospital
Repository Posting Date:
16-Jan-2012
Date of Publication:
3-Jan-2012
Sponsors:
UTHSCSA Summer Institute

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleCode White: A Planned Response to Maternal Hemorrhage in a Community Hospitalen_GB
dc.identifier.urihttp://hdl.handle.net/10755/203178-
dc.description.abstract(Summer Institute) Maternal hemorrhage is an emergent situation every maternity unit faces on a regular basis. With the advent of Pyxis and the locking of our emergency medications we faced a potentially dangerous situation. We formed a multidisciplinary team to develop a safe 'Code White Cart’ and protocol that would satisfy Joint Commission requirements, while keeping needed drugs and equipment easily accessible, then drilled staff to assure that everyone was comfortable with use of the code white cart and protocols. Through planning and drills, rare, emergent situations can be handled more safely and efficiently. Problem: Pharmacy discovered many nurses removed post-partum hemorrhage medications more often than patients experienced increased bleeding. Nurses stated concern they would not be able to access these medications in a timely manner with them locked in PYXIS. We know that women regularly have post-partum hemorrhages. We know that these hemorrhages can be very significant, and timely intervention is key to the woman's well-being. We knew that timely access to medications had been compromised by PYXIS, leading nursing staff to find "work-arounds" that would not be acceptable to Joint Commission requirements. Strategy: We decided to form a collaborative with the Quality Improvement Department, Risk Management, pharmacy, staff and leadership from Maternity, one of our obstetricians, and blood bank to address the issues and work toward a solution. Practice Change: Multiple practice changes have grown out of this initiative: (1) Creation of the multidisciplinary team; (2) All nurses have a working password on all PYXIS machines on the floor; (3) Testing of every nurses' competency in removing hemorrhage meds quickly; (4) Pharmacy monitoring of all pyxis cubbies for ease of opening, which included limiting the number of meds in each drawer; (5) Drilling w/staff and physicians to hard-wire skills; (6) Purchase and stocking of a 'Code White Cart' similar to the Cardiac Arrest carts in the hospital with all needed equipment and all non-refrigerated meds for easiest access; (6) Creation of a Code white flow sheet summary and policy and training of all staff and providers, as well as members of the Rapid Response Team and Nursing Management hospital-wide; (7) Policy for refill of cart; (8) On-going drills to maintain competency. Evaluation: -videotaping of drills indicated response time for maternal hemorrhage went from 18 minutes, to 3 minutes. We have also had a significant decrease in medications removed and stored outside of PYXIS "in case of" hemorrhage, as staff have become more comfortable that access will be available if needed. Results: See above. Recommendations: We have added the Bakri Postpartum Hemorrhage Balloon to our cart. We strongly believe in the necessity for regular drills to maintain comfort at our institution, and have also presented the information to the Rapid Response Team and Nursing Management Council. Lessons Learned: Nurses will do what they need to do to keep their patients safe. If you want them to follow the rules (etc. not going to 'inventory all meds' to get their postpartum hemorrhage medications, instead of waiting for pharmacy to 'release them' in the midst of a hemorrhage…) then you need a system that works for everyone, not just rules! Bibliography: ACOG Practice Bulletin. Post Partum Hemorrhage, Number 76, October 2006. 108(4), October 2006: pp. 1039-47. Anderson, J.M., Etches, D. (2007). Prevention and Management of Postpartum Hemorrhage. American Family Physician. 75(6). March 15, 2007. pp. 875-82. California Maternal Quality Care Collaborative. CMQCC Obstetric Hemorrhage Toolkit, Guidelines and Compendium of Best Practices. 1/6/10. pp. 1-17. www.CMQCC.org [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]en_GB
dc.subjectMaternal Hemorrhageen_GB
dc.subjectCommunity Hospitalen_GB
dc.date.available2012-01-16T11:01:42Z-
dc.date.issued2012-01-03en_GB
dc.date.accessioned2012-01-16T11:01:42Z-
dc.description.sponsorshipUTHSCSA Summer Instituteen_GB
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