ASSESSMENT OF EFFECTIVENESS OF DR.

JOSE FABELLA MEMORIAL HOSPITAL BLOOD BANK IN PROVIDING BLOOD DURING EMERGENCY OBSTETRIC SITUATIONS

A Report of a Special Study Submitted in Partial Fulfilment of the Requirements in PH 197/199, AY 2012-2013

By Aseron, Marie Grace A. Cortez, Cathlyn Marie R. De Guzman, Alethea Ann R. Remaneses, Joanna I. Sy, Krizia Felea S.

Fely Marilyn E. Lorenzo RN, MPH, DrPH Adviser

College of Public Health University of the Philippines Manila

Abstract Hemorrhage is the major cause of maternal mortality in the Philippines. Blood transfusion is found to be the most effective way to save lives of hemorrhaging obstetric cases. Being the primary maternity hospital in Metro Manila, Dr. Jose Fabella Memorial Hospital receives the most number of obstetrics admission, thus it is important that their blood bank services is effective in delivering blood to mothers who are in need. The study used a descriptive cross-sectional design to assess the effectiveness of the blood bank services. The following criteria were employed to determine effectiveness: adequacy, accessibility, affordability, safety, and timeliness. Data collection methods utilized were key informant interviews, simple policy analysis, on-site observation, and time and motion observations. Key findings of the study include: most hemorrhagic mothers were found to be young and poor; pre-natal care seemed important in preventing hemorrhage during child birth. Assessment of the blood bank services revealed that the hospital adheres to replacement blood donation policy instead of the voluntary blood donation. Strict compliance of the blood bank to ensure safe blood transfusion was observed but miscommunications between the doctors and the medical technologists were reported. Inadequate and high prices of blood units were reported by the informants. Generally, the blood bank was found to be effective in providing blood units to mothers in need in terms of accessibility, safety and timeliness. However, there is a need to improve blood bank services in terms of adequacy and affordability of blood. Recommendations regarding policies in the hospital include the incorporation of replacement blood donation in the SOPs, update existing national policies (RA 7719), and devise SOPs on the ideal turn-aroundtime. To increase the capacity of the blood bank to provide adequate and safe blood supply, it is recommended that non-functioning equipments should be repaired immediately, and regular mobile blood donations, and training workshops for laboratory staff be conducted. It is also suggested that the hospital extensively promote the importance of pre-natal check-ups as this can reduce the risk of severe blood loss during childbirth. Keywords: Hospital blood bank, maternal mortality, hemorrhagic obstetric cases, blood transfusion, blood bank policy

ii

Acknowledgement The researchers would like to extend their sincere gratitude to the following persons who made the completion of this paper possible: Dr. Fely Marilyn Lorenzo, researchers Special Study adviser, who relentlessly gave her precious time, guidance, support, and contribution to every part of this paper. Dr. Ruben Flores, medical director of Dr. Jose Fabella Memorial Hospital, for the warm welcome and recognition; Dr. Jeffrey Leonardo, chief of Medical Professional Staff, for his kind consideration to this study; Dr. Oscar Ng, chair of Pathology and Laboratory Department, and the blood bank staff for bestowing their place in data collection; Ms. Lucilla Villareal, chair of Medical Records Department, and personnel for their understanding and collaboration; Staff in Dr. Flores and Dr. Leonardos Offices and Obstetric Department for their tireless pronouncement and assistance; All doctors, medical clerks, nurses, blood bank staff and mothers for their steadfast willingness and for sharing their time in interviews; For the moral and financial support of each researchers family and friends; Most importantly God, for the divine intervention in the academic endeavour of this study.

iii