NR 452 Week 6 Quantitative Blood Loss Implementation Example

Weighing Instead of Guessing: An Implementation Plan for Quantitative Blood Loss After Vaginal Birth

Student Name

College of Nursing, Chamberlain University

NR 452: Capstone Course

Instructor Name

Month Day, Year

Weighing Instead of Guessing: An Implementation Plan for Quantitative Blood Loss After Vaginal Birth

The Change and Who Accepts It

The change is to measure blood loss after every vaginal birth on a composite 10-room labor and delivery unit by weighing blood-soaked items and measuring collected blood in a calibrated under-buttocks drape, rather than estimating it by eye. The American College of Obstetricians and Gynecologists recommends quantitative methods of measuring blood loss because visual estimation is inaccurate and tends to underestimate large losses, delaying recognition of hemorrhage (American College of Obstetricians and Gynecologists, 2019). In a simulation study, clinicians' visual estimates of blood loss after vaginal delivery varied widely and underestimated larger volumes (Toledo et al., 2007). The unit already stocks calibrated drapes and a gram scale, but they are used inconsistently, mostly when a hemorrhage is already suspected.

Before any activity is scheduled, a named role must accept the change. In this plan, the labor and delivery nurse manager has agreed to own it, and the unit's perinatal clinical nurse specialist has agreed to lead it day to day. Without those two acceptances the plan would stop on the day the writer's placement ended, so they are the first step rather than an afterthought.

Built Onto What Already Runs

The plan invents no new meetings, forms or audits. The briefing goes into the unit's existing monthly staff meeting and its daily 0700 and 1900 huddles. The prompt goes onto the delivery record's existing blood loss field, which currently accepts a free-text estimate and will be changed to require a measured value with a checkbox for method: weighed, collected in drape, or both. The teaching goes into the unit's annual obstetric hemorrhage drill, which already exists and is run by the clinical nurse specialist. The counting uses the monthly hemorrhage report the unit already sends to the hospital's quality department.

Days Numbered From a Start

Day 0: Nurse manager and clinical nurse specialist accept ownership; the manager places the change on the next practice council agenda.

Day 7: Practice council reviews and approves the plan; obstetric physicians and midwives are informed through their department meeting by the medical director, since they will see measured values rather than estimates.

Day 10: Clinical informatics is asked to change the delivery record's blood loss field to require a measured value and method; the requested completion date is day 35.

Day 14: Supply chain confirms par levels for calibrated under-buttocks drapes and places a gram scale in every delivery room rather than one shared scale.

Days 21 to 35: The clinical nurse specialist teaches the method at each huddle over two weeks, five minutes at a time, with a one-page card at each scale showing dry weights of common items and the rule that one gram equals one milliliter of blood.

Day 35: Record change goes live; measured blood loss becomes the unit's standard.

Days 36 to 90: Clinical nurse specialist reviews the monthly hemorrhage report and brings questions to the huddles.

Day 90: Practice council reviews the first two months and decides whether the change is permanent.

One Role for Each Step

Each step has one owner. The nurse manager owns approval and the staff meeting. The clinical nurse specialist owns teaching, the card and the review of the monthly report. Clinical informatics owns the record change. Supply chain owns the drapes and scales. The labor nurse caring for the patient owns the measurement at every birth, starting when the baby is delivered and continuing through the first hour after delivery of the placenta, weighing soaked pads, underpads and sponges and reading the drape. The delivering physician or midwife is informed but does not own the measurement, which remains a nursing task.

What the Teaching Covers

Each five-minute huddle segment covers one part of the method so that no single session competes with the shift. The first shows how to place the calibrated drape before delivery of the baby and how to read it once the placenta is delivered, subtracting amniotic fluid collected before birth where possible. The second shows how to weigh soaked items, subtracting the dry weight printed on the card, and how to record the total in milliliters. The third covers what to do with the number: report it to the delivering clinician aloud as a measured value, compare it with the hemorrhage protocol's stages, and continue measuring through the first hour after birth. The fourth reviews two short cases from the unit's own recent births, with identifying details removed, showing the difference between the estimate recorded and the amount later measured. Nurses who miss the huddles complete the same content at the annual hemorrhage drill, where the clinical nurse specialist checks each nurse's technique on a simulated delivery.

Resources

The plan needs one scale per delivery room, eight more than the unit owns, at about 120 dollars each, which the nurse manager has agreed to fund from the unit's equipment budget; calibrated drapes, which the unit already stocks and will now use at every birth, raising monthly use by about 100 drapes; roughly twenty minutes of each nurse's time across four huddles; and a few hours of informatics time to change the delivery record field. No new staff are needed.

Objections, Answered in Advance

Three objections are likely. Nurses will say that weighing takes time during the busiest minutes after birth. The answer built into the plan is the scale in every room and a card with dry weights, which reduce the task to placing items on the scale and subtracting; the clinical nurse specialist will time it during teaching. Some physicians will say that measured values will be higher than their estimates and will trigger unnecessary hemorrhage protocols. That is partly the point, since underestimation delays treatment, but the plan also keeps the hemorrhage protocol's existing triggers, which include vital signs and clinical judgment, not blood loss alone. Finally, some nurses may continue to estimate and write a number into the field; the required method checkbox makes that visible in the monthly report.

What Happens After the Author Leaves

The writer's placement ends before day 35. Nothing in the plan depends on the writer after day 14, when the plan and the teaching card are handed to the clinical nurse specialist. The California Maternal Quality Care Collaborative's hemorrhage toolkit, which the unit already uses, recommends quantitative blood loss as part of a hemorrhage bundle (Lyndon et al., 2015), so the change also fits a structure the unit's leaders already recognize. If the manager or clinical nurse specialist leaves, the practice council owns the decision at day 90, which keeps the plan from depending on any one person.

References

American College of Obstetricians and Gynecologists. (2019). Quantitative blood loss in obstetric hemorrhage (ACOG Committee Opinion No. 794). Obstetrics & Gynecology, 134(6), e150-e156. https://doi.org/10.1097/AOG.0000000000003564

Lyndon, A., Lagrew, D., Shields, L., Main, E., & Cape, V. (Eds.). (2015). Improving health care response to obstetric hemorrhage version 2.0: A California quality improvement toolkit. California Maternal Quality Care Collaborative.

Toledo, P., McCarthy, R. J., Hewlett, B. J., Fitzgerald, P. C., & Wong, C. A. (2007). The accuracy of blood loss estimation after simulated vaginal delivery. Anesthesia & Analgesia, 105(6), 1736-1740. https://doi.org/10.1213/01.ane.0000286233.48111.d8