Training activity information
Details
Identify the steps required to manage a case involving major obstetric haemorrhage, including:
- Supply of appropriate units including management of timelines
- Identify healthcare professional involved the patient care
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Patient blood management (PBM) measures
- When to activate MHP
- Near patient testing
- Current guidelines
- Use of haemostatic agents
- Alternative interventions for patients who refuse blood components
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to managing the laboratory aspects of a major obstetric haemorrhage case.
- Review the relevant learning outcomes specifically focusing on standards, advising professionals, management plans, and patient blood management.
- What specific steps are critical for the laboratory to support the management of major obstetric haemorrhage, particularly regarding component supply and timelines?
- What are the expected outcomes of effective laboratory support during a major obstetric haemorrhage?
- Discuss with your training officer to understand the specific protocols and expectations for your role in managing these emergencies.
What is your prior experience of this activity?
- Think about what you already know about the current guidelines for managing major obstetric haemorrhage and the use of alternatives to standard blood products.
- What are the standard blood components typically required and in what quantities for major haemorrhage protocols?
- Consider possible challenges you might face, such as:
- Rapid communication
- Managing multiple requests simultaneously
- Ensuring component availability
- Dealing with unexpected issues during an emergency
- And think about how you might handle these under pressure.
- Recognise the scope of your own practice for this activity, meaning knowing when you would need to seek advice regarding activating the massive haemorrhage protocol, component shortages, or complex patient requirements during an emergency.
- Acknowledge how you feel about being involved in managing major obstetric haemorrhage, which is a time-critical and high-pressure situation.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in rapidly assessing needs, prioritising tasks, and communicating effectively with the clinical team during an emergency.
- Identify the specific insights you hope to gain into the practical logistics of managing blood product supply, adhering to emergency protocols, and the importance of teamwork during a major haemorrhage event.
What additional considerations do you need to make?
- Consult actions identified following previous experience with issuing blood products urgently or participating in emergency simulations.
- Identify important information you need to consider before embarking on the activity, such as your institution’s specific major obstetric haemorrhage protocol, the location of emergency blood fridges, contact details for key personnel, and the process for requesting additional components or senior support.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst managing a major obstetric haemorrhage case?
- Are you encountering situations such as:
- Communication breakdowns, delays in transport, or an unexpected shortage of essential blood products
- An urgent request necessitating the issuance of alternatives to standard blood products, requiring immediate process confirmation
- Difficulty identifying and liaising with the key healthcare professionals involved in the rapidly evolving emergency
How are you reacting to the unexpected development?
- How is this impacting your actions? Did you adapt or change your approach to task prioritisation or communication strategy in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately prioritising actions and managing communication with the clinical team to adhere to required timelines
- Rapidly troubleshooting or adapting your component supply process to manage unexpected shortages or logistics
- Seeking immediate assistance or clarification from a senior colleague regarding activating the massive haemorrhage protocol or component availability during the emergency
- How are you feeling in that moment? For instance, are you finding it difficult to maintain focus and adherence to emergency protocols under high pressure? Is it affecting your confidence in managing the laboratory’s critical role?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully managing the laboratory aspects of the emergency, or needing support because the issue requires senior management intervention or falls outside standard procedure?
- What are you learning as a result of the unexpected development? For example, are you gaining crucial insight into the critical steps and coordination required in a major obstetric haemorrhage scenario, or mastering the application of emergency protocols for blood product supply?
On action
What happened?
- Begin by summarising the key points of the experience of managing a case of major obstetric haemorrhage. What were the key actions related to requesting and supplying blood components including managing timelines? How did you identify or interact with the healthcare professionals involved in the patient’s care?
- Consider specific events, actions, or interactions which felt important, such as moments where the urgency and coordination required felt intense.
- Acknowledge how you felt under pressure.
- Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded. For instance, describe when a change in the clinical situation or a request from the clinical team immediately led you to adjust the supply plan or communication strategy.
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the laboratory’s role and the required steps in managing major obstetric haemorrhage. What skills in urgent communication, coordinating blood supply, and understanding multi-disciplinary team dynamics did you develop? Were there knowledge gaps about massive transfusion protocols or the use of alternatives to standard blood products?
- Compare this experience against routine blood issue. Has your understanding of managing life-threatening bleeding improved?
- Identify any challenges you experienced e.g., communication breakdowns, logistical issues with blood supply, dealing with high stress and how you reacted to these. Were you able to overcome them effectively?
- Did you need to seek advice or clarify any aspect of the protocol or blood product requirements? Did you ensure your actions were within your scope of practice while contributing effectively to the emergency?
- Acknowledge any changes in your own feelings now you are looking back on the experience regarding your potential role in managing major obstetric haemorrhage.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt. For example, determining specific areas related to massive haemorrhage management that you need to study further e.g., local protocols, point-of-care testing, complex transfusion scenarios.
- How will this experience change your approach to urgent requests for blood products?
- Do you need to practise any aspect of the activity further, such as rapid communication, coordinating logistics, or working under pressure?
Beyond action
Have you revisited the experiences?
- Looking back at your past experiences identifying the steps required to manage major obstetric haemorrhage (MOH), have you reviewed your previous reflections? What specific areas did you focus on for improvement e.g., understanding the massive transfusion protocol, timelines for blood supply, identifying key healthcare professional? Have you actively worked on these skills, and are you now more proficient in outlining the management steps for MOH?
- Have you engaged in professional storytelling or shared experiences or discussed protocols related to managing MOH with colleagues or senior staff? Did these interactions broaden your understanding of the multi-disciplinary aspects of MOH management or improve your knowledge of alternative products?
How have these experiences impacted upon current practice?
- How does the cumulative learning from identifying MOH management steps, combined with your ongoing reflection, support your preparation for observed ‘in-person’ assessments such as a Case-Based Discussion involving a major haemorrhage scenario or an OCE where you might need to obtain a patient history related to an acute event?
- How has your ability to identify the necessary steps and processes for managing a case of MOH developed over time?
- Are you more confident in understanding the critical role of the laboratory in supporting such an emergency?
- How clearly can you now identify when the situation is escalating rapidly and requires urgent action or is outside your current expertise, ensuring you work within your scope?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Practice in accordance with antenatal serology standards and guidelines. |
| # 6 |
Outcome
Identify and advise healthcare professionals on appropriate actions to manage HDFN. |
| # 7 |
Outcome
Develop management plans including selection of blood components for mother, fetus and neonates during pregnancy. |
| # 8 |
Outcome
Identify actions required in cases of potentially sensitising events during pregnancy. |
| # 9 |
Outcome
Apply patient blood management principles during pregnancy. |