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Recommendations and best practices for preventing postoperative hemorrhage and hematoma in hospitals. It covers the importance of managing blood loss, medication management, and essential first steps for effective care. Early warning signs and protocols for rapid response are also discussed.
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How To Improve Hospital Quality and Safety
Selected Best Practices and Suggestions for Improvement
PSI 09: Postoperative Hemorrhage or Hematoma
Why Focus on Postoperative Hemorrhage and Hematoma?
Recommended Practice Details of Recommended Practice
Management of Blood Loss Proper management of blood loss, including frequent dressing checks, is key to management of postoperative hemorrhage and hematoma.^1 Medication Management Determine if and when discontinuation of antiplatelet/anticoagulant medication prior to the procedure or surgery is appropriate. 1,3,4,
Best Processes/Systems of Care
Introduction: Essential First Steps
o Identifies the purpose, goals, and scope and defines the target population for this guideline. o Analyzes problems with guidelines compliance, identifies opportunities for improvement, and communicates best practices to frontline teams. o Monitors measures that would indicate if changes are leading to improvement, identifies process and outcome metrics, and tracks performance using these metrics. o Determines appropriate facility resources for effective and permanent adoption of practices.
Recommended Practice: Management of Blood Loss
How To Improve Hospital Quality and Safety
o Consider developing a standard set of criteria or early warning signs (see below) that will be used to trigger notification of the responsible surgeon of possible postoperative bleeding. o Incorporate all components of the criteria/early warning signs into a tool designed to provide standardized documentation of all pertinent details of the event. This tool will provide the data to track patient characteristics, processes, and outcomes for continuous quality improvement. o Establish a policy to empower nurses to rapidly escalate up the chain of authority to reach the responsible surgeon (limit time to 5-minute wait after initial page before move to notify next higher level of authority). o Provide educational sessions to all clinical staff on the pilot units (nurses, residents, attending physicians, other providers, respiratory therapists, patient care technicians, certified nursing assistants, etc.) in the use of the early warning signs criteria, required documentation, and policy for rapid escalation up the chain of authority to notify responsible surgeon.
o Restlessness and anxiety. o Frank bleeding and bruising. o Tachycardia. o Diminished cardiac output and dropping central venous pressure. o Reductions in urine output. o Swelling and discoloration of the extremities.
Recommended Practice: Medication Management
o Practice recommendation should be selected based on individual patient risk factors and current evidence-based guidelines for a particular surgery.^3 ,4, o Obtain a thorough history of medication use prior to surgery. The history must specifically address the use of over-the-counter and prescribed medications.
Document this information in the patient’s medical record so that it is available to all care providers.
Educational Recommendation
Effectiveness of Action Items
How To Improve Hospital Quality and Safety
Communication
Authority/Accountability
References