The Use of Scorecards to Improve Documentation of Obstetrical Blood Loss

The Use of Scorecards to Improve Documentation of Obstetrical Blood Loss by Marilyn Cejka Steinberg MN, University of California, Los Angeles, 1979 BS, Adelphi University, 1975 Proposal Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2018 Abstract Obstetric hemorrhage is one of the most common causes of maternal morbidity and mortality. The measurement of quantitative blood loss (QBL) at delivery prevents clinicians from failing to recognize hemorrhage in healthy obstetric patients who initially compensate for excessive blood loss. The purpose of this project was to improve the compliance of labor and delivery nurses in a community hospital with consistent QBL measurement. Key theories that formed the basis for the project were Lewin’s theory of planned change and homeostasis. The project question addressed was: Is the use of weekly scorecards to provide feedback to nurses with both blinded individual data and aggregate unit data associated with an increase in the percent of patients with blood loss at delivery documented as a QBL measurement over a 12-week period of time? A blinded scorecard of the percent of deliveries attended by each nurse that had QBL documented and an aggregate run chart of the percent of all deliveries with QBL documented were posted in the unit weekly. The postings included discussions of means to enhance facilitators of and decrease barriers to QBL measurement. Over 12 weeks, the percent of deliveries with QBL documented increased from 22.7% to 80.0%. This result is consistent with previous reports that clear and objective feedback from scorecards is associated with improvement in performance. Scorecard feedback may be explored to determine if it is associated with improvement of other nursing practices. This project has implications for positive social change as it may contribute to a reduction in preventable maternal deaths. Decreasing maternal morbidity and mortality supports the health of women in a population and influences the health of the next generation.Obstetric hemorrhage is one of the most common causes of maternal morbidity and mortality. The measurement of quantitative blood loss (QBL) at delivery prevents clinicians from failing to recognize hemorrhage in healthy obstetric patients who initially compensate for excessive blood loss. The purpose of this project was to improve the compliance of labor and delivery nurses in a community hospital with consistent QBL measurement. Key theories that formed the basis for the project were Lewin’s theory of planned change and homeostasis. The project question addressed was: Is the use of weekly scorecards to provide feedback to nurses with both blinded individual data and aggregate unit data associated with an increase in the percent of patients with blood loss at delivery documented as a QBL measurement over a 12-week period of time? A blinded scorecard of the percent of deliveries attended by each nurse that had QBL documented and an aggregate run chart of the percent of all deliveries with QBL documented were posted in the unit weekly. The postings included discussions of means to enhance facilitators of and decrease barriers to QBL measurement. Over 12 weeks, the percent of deliveries with QBL documented increased from 22.7% to 80.0%. This result is consistent with previous reports that clear and objective feedback from scorecards is associated with improvement in performance. Scorecard feedback may be explored to determine if it is associated with improvement of other nursing practices. This project has implications for positive social change as it may contribute to a reduction in preventable maternal deaths. Decreasing maternal morbidity and mortality supports the health of women in a population and influences the health of the next generation. The Use of Scorecards to Improve Documentation of Obstetrical Blood Loss by Marilyn Cejka Steinberg MN, University of California, Los Angeles, 1979 BS, Adelphi University, 1975 Proposal Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2018 Dedication This work is dedicated to all of the women whose experiences with obstetric hemorrhage helped health care providers to learn better methods to prevent, recognize, and collaboratively manage the condition in order to decrease preventable maternal morbidity and mortality. Acknowledgments There are many people who provided inspiration and support to me on this journey. I thank all the dedicated clinicians with whom I practiced over the years who encouraged me to continue my education and explore means of increasing patient safety and quality of care. I thank my husband Randy, who although he did not understand why I needed to engage in this endeavor, served as my 24-hour technical support. I thank my clinical preceptor Dr. Rafael Rojas, who did his best to introduce me to Excel. I especially wish to thank my always-positive committee chairperson, Dr. Linda Matheson, and my supportive committee member, Dr. Karen Robson.