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OB Emergency Drills

OBJECTIVES. Participants will be able to describe the roles, responsibilities, and

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OB Emergency Drills

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    1. OB Emergency Drills Presented by: Tami McBride, CNM, MS Karen Carey, CNM, MS

    2. OBJECTIVES Participants will be able to describe the roles, responsibilities, and “how-to’s” involved in successfully implementing OB emergency drills. Discuss the impact of drills on clinical practice and professional roles. Plan an emergency drill program for your practice setting.

    3. PHOENIX INDIAN MEDICAL CENTER Built in 1970 149 beds – 10 bed OB unit, of which 2 are LDRs 2005 stats = 840 deliveries, about 22% C/S rate

    4. HISTORY What prompted the drills? OB Task Force formed in 2004 to address OB Department issues In reviewing certain issues, problem areas were discussed: Emergency Cesarean Section that lacked good communication and teamwork Shoulder Dystocia with nursing staff unsure of techniques

    5. HISTORY (cont.) OB Task Force created an OB Emergency Drill committee to perform emergency drills that would involve all disciplines (i.e. anesthesia, lab, blood bank, pediatrics, etc.) Emergency drills based off Dr. Michele Lauria’s “Emergency Delivery Simulations: How to Develop Effective Teamwork” workshop in August 2004, attended by Karen Carey, CNM.

    6. HISTORY (cont.) Emergency drills also based on recommendation in JCAHO Sentinel Event ALERT Issue # 30 “Preventing infant death and injury during delivery.” (July 21, 2004) OB Emergency Drill Committee consists of: Karen Carey, CNM (Chairperson) Tami McBride, CNM (Co-chair) Julia Cadwalader, RN (Nurse Educator) LeAnne Prenovost, Nurse Manager, OB Unit RN from day shift RN from night shift

    7. ADULT TEACHING/LEARNING PRINCIPLES Adults are usually self-motivated, self-directed, build on experience, prefer active involvement Provide positive environment Should use as many perceptual elements as possible: tactile, visual, auditory, kinesthetic Focus should be interpersonal & learning, meaningful & applicable

    8. TYPES OF EMERGENCY DRILLS Emergency Cesarean Section (with neonatal resuscitation drill included) Preterm Labor/Delivery (with neonatal resuscitation drill included) Postpartum Hemorrhage (some scenarios include an emergency hysterectomy) Shoulder Dystocia (with neonatal resuscitation drill included)

    9. MATERIALS NEEDED Team of knowledgeable staff Copies of your facilities’ policies and procedures Debriefing / evaluation form Real live “patient” Labor or Triage room Liter bag of IV fluid, with tubing O2 face mask Infant manikin with blankets Availability of infant warmer with O2, suction, etc.

    10. HOW DRILLS ARE CONDUCTED Some drills have an educational piece before the drill, i.e. shoulder dystocia Brief the “patient” on scenario Need 3 observers: 2 at actual scene, 1 monitoring the front desk/nursery area Participants have to actually “do” things, not just say they are doing them (except start IVs, foleys, etc.)

    11. HOW DRILLS ARE CONDUCTED Ancillary staff involvement (lab, blood bank, RT, peds, anesthesia, house supervisor, etc.) Decision to end drill Debriefing period Inservices following, prn (trendelenberg position on bed, stirrup placement on OR table, etc.) Writing up of drill and distributing write-up to all staff (for educational purposes)

    12. LESSONS LEARNED Initially used a manikin, switched to real person – more effective & believable, also got patient’s perspective of situation Communication issues Role confusion (charge RN, triage RN) How to get ancillary staff to participate Knowledge deficit in operating equipment (stirrups, bed)

    13. LESSONS LEARNED Systems Problems: Locked stairwell Elevators Blood Bank Paging errors (how to page STAT) Alarm sounds (Triage area vs. OB unit) Location of emergency call lever in the OR Location of supplies (foot stool, UVC kit, etc.)

    14. BENEFITS Improved communication & teamwork Role definitions Inservices from anesthesia (following the drill) on administration of cricoid pressure & assistance with arterial line placement Discovered need for shoe covers, masks, & hats to be stocked at the rear OR entrance – now supplies there

    15. BENEFITS Significant improvement in laboratory & blood bank services in receiving assistance and blood products needed in an emergency Improved STAT paging process Improved accessibility of supplies & knowledge of where supplies are located Hands-on working with equipment

    16. SBAR – Communication Tool S = Situation What is going on with pt? Concise statement of problem B = Background Background info pertinent to situation A = Assessment What do you think the problem is? R = Recommendation What action/recommendation is needed to correct problem?

    17. DRAWBACKS Staff hate to see you coming Staff get suspicious when you come around

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