 Well, this is Sarah Miller, Director of Partnerships here at the Patient Safety Movement Foundation. Today we are going to talk about the topic of massive transfusions in the obstetric setting. So today we're really excited and so very honored to welcome Courtney Wilson, a nurse in maternal child health. Courtney, do you mind introducing yourself? Not at all. Thanks for having me. I'm Courtney Wilson, Clinical Practice Consultant for Northern California Region at Kaiser Permanente, and I specialize in obstetrics. Great. Thank you so much, Courtney. So the first question that I have for you is, why are standardized massive transfusion protocols needed and important in the context of PPH? Absolutely. When we think about postpartum hemorrhage as a major cause of maternal morbidity and mortality, significantly and exponentially among women of color, standardizing a practice with early intervention will reduce this maternal morbidity. So when we think about the context of massive obstetric bleeding, fibrinogen is the primary and most important coagulation factor to diminish. So if early recognition of unstable bleeding is identified early, quickly, and called out in critical situations, then early supplementation of proper blood products will save lives. And so enhanced education and focus around assessment and recognition of postpartum hemorrhage is very critical when you think about developing protocols. And massive transfusion protocols are really a necessary resource and often the impetus for hospitals to ensure that the sustained availability of blood products for labor and delivery specifically exist. You know, we think about our blood banks primarily supporting surgery and trauma and the ED space, but having this massive transfusion protocol has really brought awareness and emphasis on the need to specifically have stored blood for labor and delivery and our maternal patients as needed. Great. And what's involved in creating the massive transfusion protocol in a hospital and, you know, what discipline should be included? Yeah, definitely. You want to use a validated policymaking toolkit and thoroughly examine the CMQCC postpartum hemorrhage toolkit. And when we when we start thinking about protocols and policies, I always like to do a gimbal walk a mental gimbal walk in and that means walking through every step and every role when you are activating a protocol who's involved walking through the steps and the lens of the patient. And when you do that, you realize I start from the beginning when when a hemorrhage is happening or when massive blood loss, red flags are starting to present. The surgeon's going to be, you know, the surgeon or the provider is definitely going to be the lead. And then you think about making the call out and initiating a process. So the hospital supervisor or unit operator, whoever's announcing this code and really bringing awareness to where this hemorrhage is taking place. So the surgeon, the operator, the unit assistant or a unit secretary, of course, the registered nurse or charge nurse anesthesia definitely needs to be involved. So an anesthesia provider, your blood bank technicians, whoever is operating, you know, where your blood is stored and your department leaders or your managers, your, your manager, your directors or your assistant managers, whoever it is leading taking charge of postpartum or labor and delivery that day. And what are some of the common barriers that hospitals face when it comes to effectively establishing these types of protocols. Not making sure all of the disciplines are part of the process. So everyone I just mentioned definitely needs to be at the brainstorming table, really making their role clear so that everyone knows, you know, what their job is and how they're going to participate in this massive transfusion protocol. It's important to rehearse and simulate when you don't have the critical patient in front of you. So I would say, also, not communicating the why, you know, sometimes you have to take a step back and look at statistics and metrics for people to really get a clear understanding of why we're focusing on establishing some sort of resuscitative protocol, because bleeding is the leading cause of death for moms. Another barrier is, you know, ineffective communication, you know, with the lab and everyone involved, not knowing everyone's role, not the nurses or the provider not being trusting of everyone, all the team team members and players. A barrier is also providers not transfusing properly. We think of whole blood and looking at ratios of platelets and packed red blood cells and cryo. So just not having a clear understanding of how to properly resuscitate and transfuse can be a barrier. Yeah, great points. And in addition to some of those points that you just made, what other tips can you share for hospitals to reduce delays when these emergency protocols are initiated? For sure. You definitely want to start with culture. Does your workplace, your environment, your unit have a culture that really values safety? Do you collectively collaborate? Is there a multidisciplinary team that's valued in the brainstorming and your approach to protocols? You definitely want to have point people and leads in each discipline so that when issues arise, you have someone to talk to and take your concerns to right away. So within robust establishments, there's always room for breakdown and gaps to develop. But if you have your leads identified, that will definitely help reduce any delays or gaps. We drill a ton. We have a lot of skills days. We have a lot of simulations. So practicing, practicing, practicing will definitely reduce inefficiencies and capture these barriers. Yeah, culture. Culture is just really everything you want to feel empowered and you want to feel really valued as a team member. Yeah, I couldn't agree more. Well, thank you so much, Courtney. We really appreciate you taking the time to connect with us today and providing us with some great insights on the topic of massive transfusion. So with that, I will close this out and thank you again. Thanks for having me. Thank you, Courtney.