Using a Care Pathway as part of an

integrated approach to reduce

inappropriate blood transfusion in

stable postpartum women

Mairi Harkness, Transfusion Specialist Midwife, Better Blood transfusion Programme, SNBTS

Imogen Hayward, Consultant Anaesthetist, Borders General Hospital, Melrose

May Mok, Consultant Anaesthetist, Perth Royal Infirmary, Perth

Vicki Clark, Consultant Obstetric Anaesthetist, RIE

Simpson Centre

for Reproductive

Health

Royal Infirmary of

Edinburgh

Major haemorrhage is the leading

cause of serious maternal morbidity

in Scotland

But, at SCRH, 75% of those

transfused are stable postpartum

mothers with no ongoing blood

loss

Blood Transfusion &

Mothers

Audit of stable

postpartum transfusion

? EVIDENCE OF INAPPROPRIATE TRANSFUSION

Pre-transfusion Hb range: 66-86 g/dl

17/18 women had 2or3 units RCC

8 women had discharge Hb>100g/dl

3 women had discharge Hb greater than booking Hb!

POOR DOCUMENTATION:

No symptoms of anaemia documented (55%)

No reason for transfusion documented (50%)

How practice could be

improved

1. Decision to transfuse

Guidance on Hb transfusion triggers

Reassessment between units

2. Improving documentation

Symptoms of anaemia

Reason for transfusion

Administration & observations

3. Supporting safe transfusion

Guide midwives through the process

An Integrated Approach

1. Formal guidelines for postnatal transfusion

2. An integrated care pathway for prescribing and

administering blood

3. Multidisciplinary Education

Multidisciplinary

Approach

Medical staff (anaesthetists & obstetricians)

decision to transfuse & consent

Midwifery staff

administer blood

monitor observations

influence medical staff!

Both groups document the process

Multidisciplinary Care

Pathway

Multidisciplinary Care

Pathway

Multidisciplinary Care

Pathway

Audit of Transfused

Postpartum Women

Initial Follow Up

Audit Audit

Pre-transfusion Hb 66-86g/dl 57-76g/dl

Symptoms of anaemia documented? 8/18 (44%) 10/13 (77%)

Reason for transfusion documented? 9/18 (50%) 13/13 (100%)

Total number of RCC

Units Transfused

Initial Audit

45 units transfused to 18

women

2.5 units per woman

Follow up Audit

19 units transfused to

13 women

1.4 units per woman

Going Forward

•Ongoing evaluation & review of pathway

•Ongoing education & updates

•Other clinical areas interested