Advocate Sherman Hospital
Advocate Sherman Hospital in Elgin is an acute-care facility with highly skilled physicians and clinical professionals who offer a comprehensive range of health care services. Magnet-designated, Sherman is ranked in the Top 25 hospitals in Illinois by U.S. News & World Report as a leader in advancing care and innovation.
Thinking outside the department
Postpartum hemorrhage remains one of the most dangerous conditions for new mothers, especially within 24 hours of childbirth. Jill Downey, MSN, RN, IBCLC, a lactation consultant in Advocate Sherman Hospital’s Family Birthing Center with more than 30 years of experience as a nurse, wanted to learn why this might be happening.
In order to investigate further, Jill participated in the hospital’s 2017 Evidence-Based Practice (EBP) Fellowship, hoping to enhance her skills in improving patient outcomes by bringing published nursing science to the bedside.
In reviewing literature on the subject, Jill confirmed that urinary retention is a risk factor for hemorrhage during the first 24 hours after delivery. “After an epidural in childbirth, a woman might not feel the urge to urinate. The assessments performed by the patient’s nurse were proving inaccurate in the post-partum period, especially in women with a high BMI,” Jill noted. “While retention may occur for numerous reasons, the urine volume retained creates pressure on the uterus. This prevents the uterus from contracting and closing off open blood vessels, which can contribute to increased bleeding and potential hemorrhage.”
Knowing bladder scanners are widely used in medical-surgical patients, Jill discovered that the scanner could also be used to assess if accumulating urine was in danger of displacing the uterus after childbirth. She collaborated with Dr. Jude Duval (Obstetrician), Fran Teti-Teal (Director of Family Birthing Center) and colleagues from the Family Birthing Center to create a nurse-driven protocol to assess for and intervene on urinary retention. Her argument, supported by the literature and data, was convincing enough that she was able to work with the vendor, Verathon Inc., to borrow a bladder scanning unit for several weeks during her study.
Although the sample size she focused on was somewhat small—comparing six weeks in 2016 to the same period in 2017—it was telling. The bladder scanning technique allowed nurses to implement interventions if urinary retention was noted, which resulted in a decrease in post-partum hemorrhage and significantly limited the amount of blood loss if bleeding did occur. These results were compelling! With the support of Fran, funding was made available to purchase a bladder scanner for the department, and for Jill to launch an awareness campaign that is sure to strengthen the evidence.
“Knowing how brilliant Jill is, and how global her experience and knowledge is, I really was not surprised that she was able to develop this life-saving protocol,” Fran said.