Title: Enhancing Adherence to the Massive Transfusion Protocol in Obstetric Emergencies: A Quality Improvement Audit

Abstract:

Background: our hospital is a major obstetric hospital that performs a variety of obstetrical emergent surgeries and facing many cases require massive transfusion protocol. Maintaining a balanced ratio of blood components in addition to other recommendations is the core of MTP.
Objective: to evaluate and improve adherence to the Massive Transfusion Protocol.
Methodology: The audit was conducted in Al-Elwyia Maternity Teaching hospital. eligible cases were those had transfusion of 4 units of blood within one hour, or more than 10 units over 24 hours. The study conducted from June 2022 to July 2023 over two cycle pre and post implementation of the intervention which included multiple lectures presented on separated occasions to resident doctors, blood bank employees, anesthetist, and emergency room staff. Printed posters that included the flowchart of MTP according to Green top guidelines No. 47.
Results: Total cases included in the study 273 cases (130 in the initial cycle and 143 in second cycle). The total number of transfused PRBC units was 754 units (range 4-11 PRBC units per patient) in the first cycle and 872 units (range 4-13 PRBC units per patient) in second cycle. The total number of FFP units transfused was 220 units (range 0-4) and 664 units (range 0-8) in first and second cycles respectively. The total number of platelets transfused was 115 and 592 in first and second cycles respectively. The ratio of 1:1:1 achieved only in 42 cases (32.3%) and 97 cases (67.8%). The calcium gluconate administration after 4 units of PRBS transfusion was done in 63 cases (48.5%) and 89 cases (62.2%). Post-transfusion investigations requested in 22 cases (16.9%) and 52 cases (36.4%) in first and second cycles respectively.
Conclusion: This audit concluded that adherence to MTP improved after providing lectures to the staff in addition to placement of posters that shows the steps of this protocol.

Biography:

Dr. Sarah Al-Musawi is a dedicated professional in obstetrics and gynecology, actively contributing to research, quality improvement, and education. Her research centers on enhancing maternal and neonatal outcomes, leading to publications and serving as a reviewer for medical journals. In her NHS role, Dr. Al-Musawi has spearheaded quality improvement initiatives focused on patient safety within obstetrics and gynecology. As a mentor, she supports junior doctors and students, helping them build practical skills in women’s health. Her commitment to improving standards in OBGYN and advancing medical education highlights her impact in the field.