Closing the loop –

translating strategies to
outcomes.
POGS Patient Safety Committee
 2

 We are tasked to implement programs to

benefit patient safety in obstetrics and
gynecology
 Our definition of patient safety:
Patient safety is a discipline in the health care
sector that applies safety science methods
The committee toward the goal of achieving a trustworthy
on patient safety system of health care delivery.
Patient safety is also an attribute of health care
systems; it minimizes the incidence and impact
of, and maximizes recovery from, adverse
events.

Emanuel, Linda, et al. "What exactly is patient safety?." (2008).

Our practice guidelines are part of our efforts to improve patient safety in obstetrics and gynecology:

Nieva, Veronica F., et al. "From science to service: a framework for the transfer of patient safety research into practice." (2005).
 Identification of
problem

Assessment of impact Creation of knowledge

(dashboard/statistics) on effective intervention

The safety loop

Adoption and Diffusion and

institutionalization dissminatation
 Needs
assessment

Strategy of
implementing Inventory of
patient safety interventions
program for
POGS

Comparison of
outcomes
 High maternal mortality
(failure to attain MDG)

To study strategies that

result in measurable
Evaluating outcomes, focus on
postpartum hemorrhage was
needs of POGS chosen

…due to measurable and

consistently reportable
outcomes, existence of
simple clinical practive
guidelines.
 Problem: Postpartum
Hemorrhage

Practice guideline
Assessment of impact formulation and
dissemination

The safety loop

Introduction of
intervention packages
Compliance and
(ALARM, PROMPT,
institutionalization
TEAM STEPPS,
EMOC)
 Problem: Postpartum
Hemorrhage

Practice guideline
Assessment of impact formulation and
dissemination

The safety loop

Introduction of
intervention packages
Compliance and
(ALARM, PROMPT,
institutionalization
TEAM STEPPS,
EMOC)
 Among causes of

maternal
mortality,
postpartum hemorrhage is common and
preventable/manageable using simple
interventions
 Problem: Postpartum
Hemorrhage

Practice guideline
Assessment of impact formulation and
dissemination

The safety loop

Introduction of
intervention packages
Compliance and
(ALARM, PROMPT,
institutionalization
TEAM STEPPS,
EMOC)
 Year 1 –
Survey On
Awareness And
Adherence To
CPG
 12

RESPONSE
RATE

NO. OF RESIDENTS 1018

NO. OR RESPONDENTS 785

RESPONSE RATE 77.11%

TOTAL NO. OF HOSPITALS 89

NO. OF HOSPITALS WHO RESPONDED 72

HOSPITAL RESPONSE RATE 80.90%

 13

AWARENESS
AND Of 785 respondents/1018 trainees Respondents (%)
READING Awareness of guidelines 92

OF Read guidelines 83

GUIDELINES

Aware of guidelines Read guidelines

Potential
mortality and
Yes morbidity Yes
No No
No Answer No Answer

POGS Patient Safety Committee, 2016

 Problem: Postpartum
Hemorrhage

Practice guideline
Assessment of impact formulation and
dissemination

The safety loop

Introduction of
intervention packages
Compliance and
(ALARM, PROMPT,
institutionalization
TEAM STEPPS,
EMOC)
Year 2 – Focus Group
Discussion On
Adoption And
Implementation Of
Interventions To
Decrease Postpartum
Hemorrhage
 What interventions do you use in your institution for PPH and other obstetric
emergencies?
What are the sources of these interventions?
Who/where/how were these interventions acquired?
1 2 3 4

Utilization of clinical practice + + + +

guidelines
Audit of management of obstetric + +
emergencies
Training for obstetric emergencies +

Specify:
ALARM + + +

PROMPT + +

PATIENT SAFETY +

REMARKS Alarm for

personal
PROMPT
real
 What factors do you think can improve current
interventions?
1 2 3 4

Physical plant and facilities + Red cross

__ patient monitor e.g. pulse ox + Private blood bank
__ laboratory with timely results + hospitals Drug
__ blood bank + less availability
exposed
__ embolization facilities +
__ surgical equipment
__ others____

Training and educational resources Alarm Make CPG +

prompt protocol (ALARM)
Clinical and medical resources Virtual Referral for
__ surgeon with advanced skills + training human
__ interventional radiologist + resources
__ others

Referral systems Practice Referral

drills CPG
checklist
 What factors do you think can improve current interventions?

1 2 3 4

Very effective + + +

Somewhat effective +

Not effective

comment Decrease CPG Communicate Based on

mortality rate mortality and
and blood morbidity
utilization
 What parameters do you use to measure effectiveness?
What indicators/factors do you use to evaluate/measure effectiveness?
1 2 3 4

Auditable standards Only B + + +

Specify: Mortality
Lynch B Lynch Blood
Rate of PPH and TAH and transfusion
are done internal
Rate of use blood transfusion iliac
Hospital stay
Surgical
Rate of use prophylactic uterotonic intervention
Number of
administration
drugs used /
Rate of uteretonic administration for PPH utilized
Reopening /
Rate of use maneuvers for PPH, __ surgical
bimanual compression, etc. infection -
Rate of use surgical management of PPH
ICU
Specify: B Lynch, uterine artery ligation,
internal iliac ligation, hysterectomy, others

Morbidity and mortality statistics for PPH + + Patient

notification

Use of checklist for obstetric emergencies +

 What additional interventions would you like to avail of to
improve obstetric practice and outcomes?
1 2 3 4

PHYSICAL PLANT
TRAINING + + +

CLINICAL RESOURCES + +

REFERRAL NETWORK +

OTHERS Prenata
l of
patient
Poor
prenatal
check
up in
local
centers
 How would you like to avail of these additional
interventions?

1 2 3 4
SELF + +

DOH + +

POGS + + +

INDUSTRY + + +

OTHERS EXPERTS
 What is your opinion on the results of the survey on CPG on PPH?

1 2 3 4

Very reflective

Somewhat reflective + + +

Not reflective

comment The options are CPG Answers

really not done in sometimes
the Philippines were
personal
 Problem: Postpartum
Hemorrhage

Practice guideline
Assessment of impact formulation and
dissemination

The safety loop

Introduction of
intervention packages
Compliance and
(ALARM, PROMPT,
institutionalization
TEAM STEPPS,
EMOC)
 Problem: Postpartum
Hemorrhage

Practice guideline
Assessment of impact formulation and
dissemination

The safety loop

PENDING

Introduction of
intervention packages
Compliance and
(ALARM, PROMPT,
institutionalization
TEAM STEPPS,
EMOC)
What indicators can we use in obstetrics?
?ygolocenygni esuw
enac srotacidni W
tah
Adopting best practice
RCOG
Adopting
best
practice

 RCOG
Adopting best practice
RCOG
Plan of action

Needs Provide Elicit solutions

feedback to to perceived
assessment centers gaps
Plan of action

Needs Provide feedback to centers

Elicit solutions to perceived

assessment gaps

Agree on standard measures

Inventory of Document which centers
have received/implemented
(e.g. incidence of PPH, rate
of blood transfusions,

interventions training/interventions
number/type of
medical/surgical
interventions employed)
Plan of action

Needs Provide feedback to centers

Elicit solutions to perceived

assessment gaps

Agree on standard measures

Inventory of Document which centers
have received/implemented
(e.g. incidence of PPH, rate
of blood transfusions,

interventions training/interventions
number/type of
medical/surgical
interventions employed)

Outcome Measure baseline pre

Evaluate effectiveness of
interventions by comparing

comparisons interventions post intervention outcomes

with baseline
 Sample report
Name of Hospital
Intervention: __ Patient Safety Observation Period:
Seminar __ CPG Jan – Dec
__ ALARM __ PROMPT __ 20__ to 20__
BEMOC/EMOC __ others
Parameters Baseline Post-intervention
Incidence of PPH No.__/1000 deliveries/Year No.__/1000 deliveries/Year
Rate of Blood Transfusions No. of patients ??
Medical interventions employed Use of oxytocin , ergonovine,
carbetocin, carboprost
Surgical interventions employed Uterine artery ligation, internal iliac
ligation, B-Lynch procedure,
hysterectomy
Other interventions Balloon tamponade, etc
Thank you for your
kind attention!