Quantifying blood loss (grrr...)

[airwin.rnc]

Hello all-

My hospital system just jumped on board with this new initiative that is supposed to help prevent an acute pp hemorrhage from occurring (this was the rationale given, I don't believe our system is above average in occurrences). It requires us to now weigh all blood soaked items, estimate amniotic fluid and fill out a worksheet post-delivery. All of this added to normal interventions and charting done post-delivery. It's going over like a lead balloon, both with the nurses and the docs. I realize like everything else that's thrown at us, it's not optional, but something to grin and bear. Just curious if anyone else out there is already doing this, and has it been more effective than plain old fashioned good assessment skills? Honestly they are making it harder and harder to raise patient satisfaction scores (required) when we're spending so much time doing things that take away from time for the hands-on nursing that we signed up for.

(Okay, done with the rant...)

Frustrated in Florida

[Elvish, BSN, DNP, RN, NP]

Do you guys not have the disposable plastic pouchy thing that slides under mom that catches blood etc. as she's delivering? It has markers that will give you a rough EBL. That makes everybody's life easier. I suppose you might still end up weighing pads if she ROMs but it might help in the blood loss. I feel silly for not knowing what it's called....just never thought to ask. :)

[queenanneslace, ADN, MSN, APRN, CNM]

We call the "pouchy thing" the "under butt drape" - probably not the correct term either.

Is it only the initial blood loss that needs to be weighed? Or is it all blood loss over a certain period of time postpartum?

Weighing is probably more accurate than a visual estimate. We are supposed to weigh pads if we suspect there's "increased blood loss" at any point after the immediate postpartum period.

Only weighing blood when we suspect increased blood loss isn't a very good way to assess either.

And how are you supposed to estimate amniotic fluid volume at delivery? Really? They're asking you to visually estimate a clear fluid and subtract that from the blood it's mixed with. Am I understanding this correctly? It seems to be an imperfect system.

[airwin.rnc]

We are supposed to measure until lochia flow is normal and VS are stable (. I understand extra measures if blood loss is excessive, but when you work a busy unit and you're not staffing according to AWHON guidelines it seems a lot to ask for every delivery.

[Mr Midwife, BSN, RN]

Here's something which you yanks might find usefull

http://www.medscape.com/viewarticle/823839

Over the pond in Ireland and UK we've been using a similar toolkit when doing our madatory updates and in a recent study done us midwives are more accurate with our blood loss estimates then our obstetric colleagues.