Steinberg Marilyn Cejka
Nurs Womens Health. 2019 Oct;23(5):390-403. doi: 10.1016/j.nwh.2019.07.008.
To increase the percentage of cases in which quantitative blood loss (QBL) was documented by labor and delivery nurses for women giving birth.
Quality improvement project.
SETTING/LOCAL PROBLEM: Labor and delivery unit of a community hospital in which a previous implementation of QBL measurement was not sustained.
Labor and delivery nurses were the focus of the intervention, but the entire multidisciplinary team became involved.
INTERVENTION/MEASUREMENTS: Based on literature supporting the use of scorecard feedback to stimulate performance improvement, weekly blinded individual scorecards showing the percentage of births attended by each labor and delivery nurse with QBL documented and a run chart showing the percentage of all births with QBL documented were posted on the unit and discussed during huddles for 12 weeks. Data on blood product administration were collected, and charts comparing QBL and estimated blood loss (EBL) volumes documented were shared with nurses and physicians.
Over 12 weeks, the percentage of births with QBL documented increased from 22.7% to 80.0%. Consistent with previous reports comparing QBL and EBL volumes at birth, there was a significant difference between the mean QBL volume (mean = 482.20 ml, standard deviation = 358.03) and the mean EBL volume (mean = 313.15 ml, standard deviation = 211.91; p < .001) for total births. The mean QBL volume was also greater than the mean EBL volume for vaginal and cesarean births, but those differences were not statistically significant. There was no increase in blood product administration associated with the increase in QBL documentation.
Discussing weekly scorecards and a run chart of QBL measurement was associated with an increase in documentation of QBL by labor and delivery nurses. Planning this project and discussing the results engaged the entire multidisciplinary team in more consistent measurement of QBL. The increased level of QBL documentation has been sustained for longer than 1 year.
提高分娩时定量失血量（QBL）有记录的产妇病例比例。
质量改进项目。
背景/当地问题：一家社区医院的分娩科室，此前实施的QBL测量未能持续。
分娩护士是干预重点，但整个多学科团队都参与其中。
干预/测量：基于支持使用记分卡反馈来促进绩效改进的文献，每周张贴显示每位分娩护士记录有QBL的分娩比例的盲法个人记分卡，以及显示所有记录有QBL的分娩比例的运行图，并在12周的碰头会上进行讨论。收集血液制品使用数据，并将记录的QBL和估计失血量（EBL）量的对比图表与护士和医生分享。
在12周内，记录有QBL的分娩比例从22.7%增至80.0%。与之前比较出生时QBL和EBL量的报告一致，所有分娩的平均QBL量（均值 = 482.20毫升，标准差 = 358.03）与平均EBL量（均值 = 313.15毫升，标准差 = 211.91；p <.001）之间存在显著差异。阴道分娩和剖宫产的平均QBL量也大于平均EBL量，但这些差异无统计学意义。QBL记录增加并未伴随血液制品使用增加。
每周讨论QBL测量的记分卡和运行图与分娩护士记录QBL的增加相关。规划该项目并讨论结果使整个多学科团队更一致地测量QBL。QBL记录增加的水平已持续超过1年。
