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A QUALITY IMPROVEMENT PROJECT TO INCREASE USAGE OF INTRA-OPERATIVE CELL SALVAGE IN OBSTETRICS-MAKING CHANGE STICK
Author(s): ,
Chowdhury, P.*
Affiliations:
Guy's and St Thomas' Hospital, Anaesthetics, London, United Kingdom
Pool, A.
Affiliations:
Kings College Hospital, Anaesthetics, London, United Kingdom
ESRA Academy. Chowdhury P. Sep 13, 2017; 190818
Dr. Priyakam Chowdhury
Dr. Priyakam Chowdhury

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Abstract
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Background and Aims:

The use of intra-operative cell salvage (ICS) reduces allogeneic blood transfusion by 40% and its use in obstetrics has been endorsed by many national organisations. Predicting which patients will benefit from ICS is difficult as the risk factors for postpartum haemorrhage (PPH) are wide ranging.An audit in 2014 identified the risk of significant blood loss to be higher in emergency caesarean sections and introduced new guidelines recommending the use of ICS (collection only) for all non-elective caesarean sections and included ICS as a prompt in the WHO checklist.

Methods:


A prospective audit of ICS use during elective and emergency caesarean sections was performed over 4 weeks in 2014. Other departmental staff were not made aware of the audit as we did not want the conduct of the audit to influence the results. As a result, a new protocol was introduced. Using our Epidural Audit system database, we have retrospectively assessed how ICS usage has changed over time since the new guideline and altered WHO checklist were introduced.


Results:

Our audit demonstrates that the change in guidelines and inclusion of a specific prompt regarding ICS usage in the WHO checklist has had a significant and positive effect on ICS usage. However, usage shows a gradual decline due to factors such as time pressures, unfamilarity with equipment and multidisciplinary engagement. 

Conclusions:

Our audit demonstrates the point of securing sustainability and addresses the challenges of maintaining change in a department with frequent staff changes, periods of intensive workload and offers possible solutions to secure sustainability.

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