Jul 092018

OBS Cymru, the all-Wales collaborative quality improvement project aiming to reduce harm from postpartum haemorrhage, has been shortlisted for two awards this year at the Patient Safety Awards and NHS Wales Awards.

We’ve been getting an update on the project from its two national lead midwives, Elinore Macgillivray and Kathryn Greaves.


For anyone who hasn’t heard of OBS Cymru, can you start by giving an overview?

Elinore: Postpartum haemorrhage (excessive bleeding after childbirth) is the second leading cause of direct maternal death in the UK, and accounts for 80% of maternal morbidity.1 in 20 women will experience a postnatal blood loss in excess of 1 litre, and for 1 in 200 life threatening bleeding will occur, leading to a number of adverse physical and emotional consequences. Rarely (around once every 3 years in Wales) postpartum haemorrhage (PPH) will result in a baby that goes home without its mother. This being so, there was a clear need for quality improvement in the management of PPH, with all the Health Boards in Wales agreeing to take part in the project.

Kathy: PPH is in the top five quality and safety risks identified for every maternity unit in Wales. OBS Cymru – the Obstetric Bleeding Strategy for Wales is a three year national quality improvement project, now in its second year, aiming to reduce harm from PPH. The primary aim of the project is to reduce the number of women suffering a massive obstetric haemorrhage.

How is the project meeting its aims?

Elinore:  Since the project was first launched in November 2016 a number of interventions have been put in place across all Obstetric led labour wards in Wales, and having positive results:

  • Risk Assessment for PPH is now becoming a routine part of the admission process in obstetric led birth settings, leading to increased awareness of and early planning for PPH detection, prevention and management.
  • Early identification by means of Measuring Blood Loss is quickly becoming embedded in practice, with over 90% of women having their postnatal blood loss measured.
  • Multidisciplinary Team Working is improving as a result of the training provided by OBS Cymru teams. Clinicians including Midwives, HCAs, anaesthetists, obstetricians, ODPs, and students working in maternity settings have received OBS Cymru training, and have embraced the 4 stage approach to PPH management.
  • ROTEM point of care testing machines have been installed in every labour ward in Wales to allow access to rapid coagulation results and guide blood product management. Early data suggests this is leading to a decrease in the administration of blood products for the reason of PPH.

Kathy:   These interventions are supported by a robust system of data collection by local OBS Cymru champion teams, we have a dedicated team in every obstetric led labour ward in Wales.  Local teams utilise this data collection to analysis and establish areas for improvement within their own health boards.  The Champion teams attend national meetings in which clinical examples presented show how the OBS Cymru principles supported resolution and improved outcomes for women.  In addition the Midwives from each of the health boards meet annually to review and share learning and take this back to their health boards to disseminate good practice.

Are you seeing any changes since the project was first launch in May 2016?

Elinore – Early data is showing that now over 90% of women are having their blood loss measured, which empowers clinicians to provide the right treatment to the right women at the right time. Blood product usage due to PPH is also beginning to decrease.

Kathy: OBS Cymru is a live quality improvement project and there are daily conversations about good practice happening in the health boards and about it’s impact on practice.  One health board has incorporated the risk assessment as part of their multidisciplinary handover when reviewing the women in labour so that as a team they know and are aware of any potential risks and make appropriate preparations as a team prior to delivery.  Others have noted a potential risk when using drapes during delivery and the hidden blood loss which is collected.  A simple solution of using the suction tubing during a procedure placed in the drape has fixed this potential to miss the slow steady bleed which goes unrecognised.  These gems of learning are being shared across Wales so that others can benefit from practice examples and our Champion teams are integral to the dissemination of this.  We are absolutely thrilled that the project has been recognised in the Patient Safety and NHS Wales Awards.  We are privileged to have been shortlisted and recognise that we are fortunate to be representing all of Wales maternity services and that this award is for them and their hard work and commitment to the project.

What makes you both so passionate about this project?

Kathy:  It’s always humbling to see the growth in confidence of myself as a practitioner and my midwifery colleagues as a profession and their integral role in managing PPH.  The 4 stage paper work has given midwives an indicative tool that is diagnostic of PPH and that it has formalised defined trigger points for action that supports the team’s situational awareness when managing obstetric bleeding. Everyday midwifery teams go to work intent on doing a good job, this is one tool in their armoury to achieve this day in day out, from Bangor in the North to Carmarthen in the West and Cardiff in the South, once for Wales.

Elinore: It’s a privilege to be involved in a project that is not only improving outcomes for women, but also empowering teams to use the skills they have acquired to have the confidence to provide the right treatment to the right women at the right time. Measured blood loss is becoming a powerful tool for communication during postpartum haemorrhage, improving team working.  An important part of the project is the women’s experience. Our patient survey shows that although PPH can be a frightening experience, women and their birth partners feel confident that they are receiving a high standard of care, which is very pleasing.

Two years into a three year project, what does the future hold for OBS Cymru?

Elinore:  Although we have made great inroads towards improving care during a PPH, we will continue to work on sustaining these changes beyond the lifespan of the project. The OBS Cymru approach to PPH management has now been incorporated into All Wales PROMPT as an integral part of sustaining the principles of risk assessment, measuring blood loss, early MDT involvement, and ROTEM POCT testing. We are also keen to see how the data reflects these changes.

Find out more about OBS Cymru here and follow the conversation on Twitter #OBSCymru

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