documentation of this program. Finally, long-term

goals involve promoting depression screening in

all obstetrician o⁄ces associated with this hospital

and supporting a collaborative network within the

community dedicated to improving the mental

health of perinatal women.

Packed and Wearing Pink: Damage Control

Surgery in the Obstetric Operating Room

Poster Presentation

Evaluation of hospital practice standards to im-

prove practice and patient outcomes must

occur on a routine schedule. During a review of our

hospitals Sponge, Sharp and Instrument Count

Policy, it was identi¢ed that a communication sys-

tem needed to be developed for the severely

injured, unstable, surgical patient who required ab-

dominal packing and required immediate transfer to

a surgical trauma intensive unit for stabilization.

Damage control surgery has had a major impact

on the survival rate in the severely injured trauma

patient, especially one who has sustained a life-

threatening injury such as liver rupture. Although

damage control surgery continues to be a mainstay

in trauma surgery, its use in the obstetric (OB) pop-

ulation within our institution has become a

standard of care when the unexpected occurs in

the OB operating room. Damage control surgery

has had a direct impact on the survival of patients

who experienced a liver rupture and unstable, sur-

gical, amniotic emboli patients.

Evidence suggests that abdominal packing and a

staged repair of hepatic and retroperitoneal injury

are more e¡ective if instituted early as part of the

resuscitative e¡orts in the management and pre-

vention of the lethal triad of hypothermia, acidosis,

and coagulopathy. Because the time to reoperation

varies between 8 hours and 10 days, a team of op-

erating room nurses, intensive care nurses, and

obstetric nurses developed a patient safety process

to prevent retained sponge(s) following damage

control surgery. Communication between the OB

unit, Surgical Intensive Care Unit, and Operating

Unit is a critical safety factor that needs to be initi-

ated with the packing procedure and continues

through the ¢nal operative procedure and removal

of packing.

The team decided that when a patient has damage

control surgery, a pink bracelet would be applied to

alert the Intensive Care Unit bedside nurse that the

patient has abdominal packing, and a packing log

is included in her chart to be used when packing is

removed or when packing is added. The presenta-

tion discusses the development the packing log

process to prevent retained sponges following dam-

age control surgery in the OB patient. Included in

the presentation are three OB patient scenarios

where favorable outcomes depended on damage

control surgery and communication between

disciplines.

Scheduled Cesarean Delivery: Start-Time

Performance Improvement Initiative

Poster Presentation

Service e⁄ciency and e¡ectiveness are impor-

tant concerns for many hospitals today. This is

particularly true in the operating room (OR), which is

one of a hospital’s largest revenue-producing cost

centers.The Scheduled Cesarean Section (C/S) pro-

ject began in 2005 with the perception that cases

were delayed and the Obstetric OR was run in aman-

ner that did not meet the surgeon, anesthesia,

or the patient needs. These perceptions often led to

frustration and hostility among team members,

which greatly a¡ected employee, physician, and pa-

tient satisfaction. This performance improvement (PI)

Nancy Skinner, MSN, RNC,

Women’s & Children’s Ser-

vices, Christiana Care Health

Services, Newark, DE

Childbearing

JOGNN 2010; Vol. 39, Supplement 1 S39

Skinner, N. I N N O V A T I V E P R O G R A M S

Proceedings of the 2010 AWHONN Annual Convention