272: Using checklists in postpartum hemorrhage care: professionals' views on the strategy

Evaluating the implementation strategy for the postpartum hemorrhage (PPH) guideline on professional level. The implementation strategy consisted of outpatient-clinic checklist (OPC), high-risk patient-information (PIF) and labor ward checklist (LWC) with HR patient identification, time-out (TO), and PPH treatment checklist (PPH-C). 3 hospitals (academic (AH), teaching-non-academic (TH) and non-teaching (NTH)) participated. Goals were increase of knowledge, communication, collaboration, HR patient recognition and information provision. Semi-structured interviews with obstetric professionals (gynecologists, residents, midwifes, nurses) were held to evaluate the strategy after a minimum period of 4 months. The interviews were divided in 3 parts: exposure, experience (format & self-assessed effectivity) and overall remarks. The OPC was assessed as easy to use with clear format. The PIF was seen as valuable reference material. There was initial hesitation concerning time-efficiency and out of fear to scare patients, to discuss the increased PPH risk, but when given the PIF it was easily accepted by patients. The PPH-C was mentioned as initially overwhelming, yet after using it became more familiar and workability improved greatly. All tools were judged as increasing knowledge. The TO felt to improve communication among team members. The LWC as a whole, with the main focus on the TO, was chosen as most valuable tool. Main difference between the hospitals was the reported incorporation into daily use. The AH had the greatest exposure, the NTH the least. The trial period was considered too short for full incorporation of the strategy. After finishing the trial all three hospitals requested to continue to use (part of) the strategy in their standard care. Overall the experience of the professionals was very positive. The TO was chosen as most valuable, and most wished to continue to use this after the trial. In 2015 the strategy will be implemented nationally as part of the new PPH guideline.