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Informatics Project: Quantitative Blood Loss

Mariah Little
Delaware Technical Community College
NUR410 – Nursing Informatics
Dr. Chance
April 8, 2024
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Obstetrical Hemorrhages

In my field of nursing of obstetrics, there are many things we are continuously

monitoring our patients for, with one being the risk of hemorrhage. Postpartum hemorrhage is

the leading cause of death in obstetrics. 11% of the maternal deaths in the US are postpartum

hemorrhage. Followed by blood transfusions required due to hemorrhage being the number one

morbidity in postpartum mothers (Smith et al., 2019). These mothers are embarking on the best

moment in their life, no families should have to be shattered with the news that their loved one

has died of a preventable cause. Most problems lie in the identification and treatment of a

postpartum hemorrhage. These maternal deaths caused by hemorrhage are 54-93% preventable

(Smith et al., 2019). To prevent and monitor the risks of postpartum hemorrhage, obstetrical

nurses are constantly using computers to help assess and monitor the potential for a postpartum

hemorrhage.

Estimated Blood Loss

Currently, my facility enforces the estimation of blood loss post-delivery. The process

involves the provider giving an estimation post-delivery of how much blood loss occurred. It is

then followed by the nurse using his or her judgment of how much blood they see on the pads.

The difficulty with this is that providers tend to underestimate the amount of blood loss with no

exact measurement to be followed for interventions or such. In studies conducted, overestimation

has also been heavily reported.

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Doctor announces an
estimated amount of
blood loss post
delivery

Nurse performs fundal

checks and estimates
blood loss by
documenting: none,
scant, moderate, or
heavy

Manually
documents
findings in
electronic
medical record

Nurse must
recognize and use
judgement when
blood loss could be
excessive (more
room for error)
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Quantified Blood Loss

There can be a way to get an exact amount of how much blood the patient lost post-

delivery and continues to lose during the postpartum period. Quantification of blood loss is an

objective measure of how to keep track of how much the patient lost. The process involves the

physician measuring the exact blood loss in a drape post-delivery minus the amount of amniotic

fluid that was in there from the delivery of the baby. The nurse then continues to measure blood

loss by measuring items used to collect bleeding (pads, chux pads, icepacks, etc). This is done by

taking the wet pad minus the dry weight of the pad. The use of informatics can come into play

through scales and tools in the electronic medical record to help. A scale that communicates to

the electronic medical record could help facilitate this. The nurse would select the item that they

are weighing. Then place those items saturated with blood on the scale. The scale would then

deduct the dry weight and send the weight over to the patient's chart in the electronic medical

record. When assessing cost-saving measures or in the event that a scale would not be operating

properly a section of the electronic medical record that easily aids in the facilitation of

quantitative blood loss would be initiated. In this case, the nurse would take the total weight of a

single item. The nurse would then go into the quantitative blood loss section in the electronic

medical record. They would put the weight of the object they weighed in the section that

correlates with what it is. The computer would have dry weights pre-programmed and minus the

dry weight from the weight the nurse enters and then charted would be the exact blood loss on

that item. The electronic medical record would also be programmed to send a notification to the

nurse when the totals exceed 500mL increments. This would then trigger the nurse to notify the

provider of the blood loss. Starting at 500mL would allow early notification and action. The new

process would improve patient outcomes by aiding in this earlier recognition and therefore
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earlier treatment. Also, the use of more alert systems and calculations continuously eliminates

more potential for user error. Through studies conducted on root causes, a majority of the

problems have been delay in diagnosis and a delay in treatment. These studies in return

significantly reduce maternal mortality and morbidity (Smith et al., 2019).

Nurse collects chuck pad

Nurse collects chuck pad
underneath patient, peri
underneath patient, peri
pad and ice pack saturated
pad and ice pack saturated
with blood
with blood

Clicks chuck pad, peri pad,

RN weighs chuck pad, and ice pack on scale (to
peri pad, and ice pack deduct dry weight)
separately on scale

Places chuck pad, peri pad,

RN charts exact weight and ice pack on scale
scale reads in electronic
medical record in column
that reads what was
weighed (period pad, Scales sends weight over to
chuck, and icepack) electronic medical record
converting grams to mL’s

Electronic medical record keeps total

quantitative blood loss recorded and
sends a notification when total
reaches equal to or greater than 500,
1000, 1500, 2000, and each 500 mL
increase
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The use of technology to quantify blood loss would allow for earlier detection and would

help decrease the number of preventable postpartum hemorrhages. Such delays in recognition of

postpartum hemorrhage can result in costly treatment (Gams & Manning, 2021). In the long run,

this would be a cost-saving measure. Earlier detection of a hemorrhage means a decrease in

expensive equipment to be potentially needed due to late intervention. Sometimes a hemorrhage

can require the need of the operating room and blood products. This measure would help early

intervention and a decrease in supplies used for postpartum hemorrhage. A decrease in

hemorrhages would also be an improvement in care.

Legal/Ethical Issues

Application of ethics to postpartum hemorrhages and quantification of blood loss various

ethical principles come into play. When choosing to switch from estimated blood loss to

quantification of blood loss, it is all for the best interest of the patient and demonstrating the

ethical principles of beneficence (Sewell, 2019). The use of quantification is in hopes of earlier

recognition of hemorrhage for treatment and in return doing what is in the best interest of the

patient. Another ethical principle that can come into stake is fidelity (Sewell, 2019). When

charting quantified blood loss, it is important to weigh the items. It is a new process and switches

from before of just looking at an item and guessing how much blood has been lost. Therefore, the

nurse needs to show honesty and perform the action of weighing items and not just use the

guessing method and therefore would not be telling the truth essentially.

Information security is prevalent in many parts of nursing. Through my topic of

quantification of blood loss, would involve the electronic medical record. In any part of the

electronic medical record, nurses must be vigilant to not share information. Provision 3 in the

code of ethics applies to this topic. It is part of the nurse's ethical duty to keep patient
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information private and confidential (Sewell, 2019). When using any part of electronic medical

records, there is potential for a data security breach.

Quantitative Blood Loss Policy

I. PURPOSE: The purpose of this policy is to improve responsiveness to postpartum

hemorrhages through the implementation of accurate measurement of blood loss.

II. POLICY: Education and demonstration on how to use scales properly and how to

operate blood loss band in electronic medical records.

III. PROCEDURE:

A. Patient gives birth, and the doctor announces blood loss total from drapes.

B. RN continues to assess fundal height and bleeding.

C. RN takes blood-saturated items to scale to weigh them.

D. Scale automatically sends information to the patient's electronic medical record.

E. RN can also add additional totals if needed in the EMR band.

F. EMR band sends active notifications to RN when blood volumes exceed 500ml

increments.

IV. RESPONSIBILITIES:

A. RNs are responsible for weighing and counting all items saturated in blood.

B. RNs are responsible for cumulative blood loss amounts and notification of physician

when increments exceed 500ml.

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C. RN must practice beneficence and adhere to the process of blood loss measurement.

D. RN must adhere to strict HIPAA compliance when accessing and utilizing all

patients’ EHRs and to not breach patient confidentiality.

Conclusion

Overall, it is essential to manage the blood loss of postpartum mothers and improve

outcomes of preventable deaths from postpartum hemorrhages. By completing quantitative and

cumulative blood loss through electronic scales and bands in the electronic medical record this

could not be done without informatics. These new strategies and the policy implementation has

the potential to become a life-saving intervention for new mothers who are just trying to enjoy a

moment that should be the happiest one of their life. This measure also has the opportunity to

increase safety and decrease healthcare costs. Therefore, in the long run, being a benefit to the

patients and the hospital system.

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References

Gams, B., & Manning, W. (2021). Quantification of blood loss: Awhonn Practice Brief Number

13. Journal of Obstetric, Gynecologic & Neonatal Nursing, 50(4), 503–505.

https://doi.org/10.1016/j.jogn.2021.04.007

Sewell, J. P. (2019). Informatics and nursing: Opportunities and challenges (Sixth). Wolters

Kluwer.

Smith, C. M., Borders, A. E., & King, T. L. (2019, December). Quantitative blood loss in

obstetric hemorrhage. ACOG.

https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/12/

quantitative-blood-loss-in-obstetric-hemorrhage