Making healthcare remarkable Using fake mommies to change real patient care Stacy Seay Capel MSN, RN, CHSE Lindsey Horne MHA, BSN, RN-MNN Eileen Frager BSN, RNC-OB Allison Talbert BSN, RNC-OB Teresa Shelton BSN, RNC-MNN Culver Nursing Education Lab Novant Health Presbyterian Medical Center Charlotte, NC February 16, 2016

Objectives: Describe the creation and implementation of a regional obstetric simulation program. Share examples of evaluations, educational supplements and post simulation follow-up. Discuss practice improvements and educational initiatives based on program results

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Novant Health Presbyterian Medical Center

School of Nursing

Margaret Jean Norwood Culver

Background: Novant Health (NH) is a regional healthcare provider with: 25,000 team members 13 hospitals 100 outpatient facilities 350 physician practices

NH Greater Charlotte Market is located in southern North Carolina and includes three Magnet designated hospitals totaling > 8,300 births/ year: NH Presbyterian Medical Center: 620 beds NH Matthews Medical Center: 146 beds NH Huntersville Medical Center: 91 beds

NH Greater Charlotte Market has an established simulation program, including: Mobile simulation unit High fidelity maternal / fetal simulator Multidisciplinary, in situ simulation experience

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Regional OB Simulation Objectives: Create and implement a regional obstetric simulation education plan Provide opportunities for women’s services staff to experience high intensity, low frequency simulated clinical emergencies in a safe environment Utilize the planned experiences to promote engagement, team building and process improvement

Assesment: In January of 2015 a needs assessment was completed utilizing: risk management statistics review of the California Maternal Quality Care Collaborative staff survey results physician input

Action: Three OB emergencies were identified as events that had high staff interest, could safely be replicated through simulation, would impact team practice and patient outcomes: prolapsed cord postpartum hemorrhage intrapartum maternal code

Education plans, scenarios and audit tools were designed. Nursing, MD’s, anesthesia, NNP’s, ICN, surgical techs, public safety, chaplaincy services, house supervision, respiratory care, rapid response teams, administration, laboratory services and pharmacy participated in the events.

Objectives for Intrapartum Maternal Code: Recognize symptoms of cardiac arrest Demonstrate timely execution of OBLS emergency skills in a safe environment Practice effective communication between all team members Participate in timing and evaluation of process

OBLS: Arrest in Pregnant Patient Immediately call for HELP: Emergency code cord/button Start Compressions  Call OB team ___________  Get code cart ___________  Primary RN Communicate SBARQ With OB ________________  Call Anesthesia _________  Bed to CPR position _______________  SBARQ Rapid Response/NICs __________  Call Rapid response/NICs ___________  Scrub tech w c/s tray w disposable scalpel ____________  SBARQ Anesthesia _____________  Call NICU _____________  Assign timer/documenter _____________  SBARQ NICU _______________

Lucie Purple 37YO 253 lbs 5’8 S:The patient is a 37-year-old female just admitted to L&D at 38 weeks, 12 hours with ruptured membranes and contractions every 3 to 5 minutes. B: Type I diabetes, has been on bed rest since 32 weeks due to labile blood sugars and preterm contractions. Primagravida Allergies: No known drug allergies Medications: insulin pump Code Status: Full code Social/Family History: Lives with husband, school teacher A: You are entering the room to assess & complete the admission

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3 scenarios 3 facilities 5 educators 10 months 14 departments 19 simulated clinical events 207 multidisciplinary participants

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Changes Implemented: Emergency c/s delivery pack reconfigured Rapid Response Team granted badge access to women’s services Bimanual uterine massage educational initiative Introduction of quantitative blood loss communication and measurement standards

Recognition of need for competencies related to sterile vaginal exams performed outside labor & delivery Postpartum hemorrhage tool boxes and Pyxis medication bundles created Team communication related to hemorrhage protocols and emergency role assignment Betadine availability in the women's services OR

References: Clapper, T. C. (2013). In Situ and mobile simulation: Lessons learned… authentic and resource intensive. Clinical Simulation in Nursing, 9(11), e551-e557. Jeffries, P.R. (2007). Simulation in nursing education. New York, NY: NLN. Lyndon, A., Johnson, M., Bingham, D., Napolitano, P., Joseph, G., Maxfield, D. & O’Keeffe, D. transforming Communication and safety culture in intrapartum care. Obstetrics & Gynecology, 125(5), The INACSL Board of Directors (2015, June). Standards. Clinical Simulation in Nursing, 11(6), doi: /j.ecns Troiani, N., Harvey, C., & Chez, B. (Eds.). (2013). High-Risk & critical care obstetrics third edition. New York, NY: Wolters Kluwer Health Lippincott Williams & Wilkins..

Making healthcare remarkable Contact Information Stacy Seay Capel MSN, RN, CHSE