- Email: [email protected]
Check One, Check Two, Check Three. Implementation of a Shoulder Dystocia Checklist in the Labor and Delivery Unit
I N N O VAT I V E P R O G R A M S
Rice, D. L.
Proceedings of the 2013 AWHONN Convention
Check One, Check Two, Check Three. Implementation of a Shoulder Dystocia Checklist in the Labor and Delivery Unit Purpose for the Program houlder dystocia is an obstetric emergency that requires teamwork, effective communication, and collaborative documentation. The labor Robin Lynn Driver, RN, C-EFM, BS, Mount Carmel and delivery (L&D) unit is an area of high liability. Health System, Westerville, OH The shoulder dystocia checklist was designed to assist staff with management and documentation and, thus, improve patient safety. Keywords Pamela A. Foley, BSN, RNC, C-EFM, Mount Carmel East Hospital, Columbus, OH
S
shoulder dystocia checklist
Childbearing Poster Presentation
Proposed Change To implement a shoulder dystocia checklist to improve standardized management and collaborative documentation and, thereby, improve maternal and neonatal outcomes. Implementation, Outcomes, and Evaluation The nurse manager, clinical educator, and a physician champion developed a checklist. It was introduced to the L&D nurses during designated days of education so that they would have the opportunity to test the process. Staff provided feedback and the checklist was revised according to their suggestions. The checklist was placed in every L&D room in a specific location next to the infant warmer. During a shoulder dystocia, staff called for help and the checklist was immediately implemented to provide a standardized approach to management and collaborative documentation.
The checklist was used as a worksheet and was not a permanent part of the medical record. Postdelivery, the team (i.e., L&D registered nurse [RN], obstetrician, certified nurse–midwife, and neonatal intensive care unit RN) used the checklist to collaboratively document staff arrival times, maneuvers, and patient response to maneuvers. The checklist was trialed with positive feedback. The nurses had a vested interest because they assisted with the revisions. The checklist has been adopted system wide. The medical record shows improved adherence to standardized management and documentation consistency during shoulder dystocia emergencies. In addition, nurses have reported increased confidence with their roles and responsibilities during this critical event. Implications for Nursing Practice Risk factors for shoulder dystocia may be present, but shoulder dystocia cannot be predicted or prevented. Therefore, it is imperative that shoulder dystocia training and simulation drills be a focus of ongoing education in the L&D unit. The shoulder dystocia checklist is a valuable tool used to guide management and collaborative documentation during this emergency situation.
Implementing a Monthly Interdisciplinary Team Meeting to Promote Optimal Outcomes for High-Risk Obstetric Patients and Their Newborns Debbie L. Rice, RN, BSN, Purpose for the Program University of Oklahoma Health oordination of care for high-risk obstetric paSciences Center, Oklahoma tients and their infants is vital to promoting City, OK
C
Keywords coordination of care interdisciplinary team collaboration optimal outcomes
Childbearing Poster Presentation
optimal outcomes. When an obstetric patient receives a diagnosis of some form of fetal anomaly, she begins to receive close follow-up care and supervision. The patient also needs to obtain additional information about the fetal diagnosis and have questions answered. Information can be provided by prenatal consults with a neonatologist or other pediatric specialists that will be involved with the infant’s care after delivery and by other personnel, such as nurses, social workers, and hospital chaplains. A coordinated plan of care promotes the exchange of information between physicians and all other healthcare professionals involved in care of the mother and infant.
JOGNN 2013; Vol. 42, Supplement 1
Proposed Change To develop a comprehensive plan of care for both mother and infant. Under the direction of an obstetric geneticist at the Oklahoma University Medical Center, an interdisciplinary team was developed. All staff that might be involved with planning and coordination of care were invited to the initial meeting. A discussion was held to review the basic format of the proposed monthly meeting. All in attendance agreed to the model. Implementation, Outcomes, and Evaluation A spreadsheet was developed to enter each month’s new patients. The data in the spreadsheet included basic demographic information, expected date of delivery, parity, fetal diagnosis, maternal issues, and the suggested plan of care.
S13
Rice, D. L.
Proceedings of the 2013 AWHONN Convention
Check One, Check Two, Check Three. Implementation of a Shoulder Dystocia Checklist in the Labor and Delivery Unit Purpose for the Program houlder dystocia is an obstetric emergency that requires teamwork, effective communication, and collaborative documentation. The labor Robin Lynn Driver, RN, C-EFM, BS, Mount Carmel and delivery (L&D) unit is an area of high liability. Health System, Westerville, OH The shoulder dystocia checklist was designed to assist staff with management and documentation and, thus, improve patient safety. Keywords Pamela A. Foley, BSN, RNC, C-EFM, Mount Carmel East Hospital, Columbus, OH
S
shoulder dystocia checklist
Childbearing Poster Presentation
Proposed Change To implement a shoulder dystocia checklist to improve standardized management and collaborative documentation and, thereby, improve maternal and neonatal outcomes. Implementation, Outcomes, and Evaluation The nurse manager, clinical educator, and a physician champion developed a checklist. It was introduced to the L&D nurses during designated days of education so that they would have the opportunity to test the process. Staff provided feedback and the checklist was revised according to their suggestions. The checklist was placed in every L&D room in a specific location next to the infant warmer. During a shoulder dystocia, staff called for help and the checklist was immediately implemented to provide a standardized approach to management and collaborative documentation.
The checklist was used as a worksheet and was not a permanent part of the medical record. Postdelivery, the team (i.e., L&D registered nurse [RN], obstetrician, certified nurse–midwife, and neonatal intensive care unit RN) used the checklist to collaboratively document staff arrival times, maneuvers, and patient response to maneuvers. The checklist was trialed with positive feedback. The nurses had a vested interest because they assisted with the revisions. The checklist has been adopted system wide. The medical record shows improved adherence to standardized management and documentation consistency during shoulder dystocia emergencies. In addition, nurses have reported increased confidence with their roles and responsibilities during this critical event. Implications for Nursing Practice Risk factors for shoulder dystocia may be present, but shoulder dystocia cannot be predicted or prevented. Therefore, it is imperative that shoulder dystocia training and simulation drills be a focus of ongoing education in the L&D unit. The shoulder dystocia checklist is a valuable tool used to guide management and collaborative documentation during this emergency situation.
Implementing a Monthly Interdisciplinary Team Meeting to Promote Optimal Outcomes for High-Risk Obstetric Patients and Their Newborns Debbie L. Rice, RN, BSN, Purpose for the Program University of Oklahoma Health oordination of care for high-risk obstetric paSciences Center, Oklahoma tients and their infants is vital to promoting City, OK
C
Keywords coordination of care interdisciplinary team collaboration optimal outcomes
Childbearing Poster Presentation
optimal outcomes. When an obstetric patient receives a diagnosis of some form of fetal anomaly, she begins to receive close follow-up care and supervision. The patient also needs to obtain additional information about the fetal diagnosis and have questions answered. Information can be provided by prenatal consults with a neonatologist or other pediatric specialists that will be involved with the infant’s care after delivery and by other personnel, such as nurses, social workers, and hospital chaplains. A coordinated plan of care promotes the exchange of information between physicians and all other healthcare professionals involved in care of the mother and infant.
JOGNN 2013; Vol. 42, Supplement 1
Proposed Change To develop a comprehensive plan of care for both mother and infant. Under the direction of an obstetric geneticist at the Oklahoma University Medical Center, an interdisciplinary team was developed. All staff that might be involved with planning and coordination of care were invited to the initial meeting. A discussion was held to review the basic format of the proposed monthly meeting. All in attendance agreed to the model. Implementation, Outcomes, and Evaluation A spreadsheet was developed to enter each month’s new patients. The data in the spreadsheet included basic demographic information, expected date of delivery, parity, fetal diagnosis, maternal issues, and the suggested plan of care.
S13