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Does Simulation Team Training in Obstetrics Make a Difference?
INNOVATIVE PROGRAMS Proceedings of the 2010 AWHONN Annual Convention
Does Simulation Team Training in Obstetrics Make a Difference? Poster Presentation Background he simulation of high-risk situations to promote learning and improve performance is not a new concept. The aviation industry is a well-known example of this. Pilots must test and train in £ight simulators on a regular basis (Reznek et al., 2003). Nursing students train in skill labs prior to actual patient care experiences. Anesthesia and Emergency Departments are using simulation training to improve performance in emergency situations (DeVita, Schaefer, Lutz, Wang, & Dongill, 2005). An obstetric simulation program promotes a rapid and organized response to these emergent situations. The Obstetric Quality and Safety Team at our hospital decided that obstetric simulations would be the best way to combine emergency drills, multidisciplinary team building, and improved communication. Obstetric emergency simulation drills were conducted at the obstetric units of both Atlantic Health hospitals in 2008. The two sites include a regional perinatal center and a perinatal intensive center. The combined total number of annual deliveries for both sites was 6,300. All simulations utilized the same scenario and were facilitated by the same personnel to provide continuity. Simulation of a patient presenting in hypertensive crisis included at least one primary care provider and two or more nurses. During the simulation experience, the use of antihypertensive and anticonvulsant medication administration was reviewed. Participants included 95% of obstetric nurses, 93% of obstetric hospitalists, and 63.5% of private attending obstetricians and certi¢ed nurse midwives at both hospital sites. The objective was to determine if the implementation of obstetric simulations speci¢c to hypertension in pregnancy would have an impact on the care of patients.
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collection before and after obstetric simulation was introduced during the second quarter of 2008. The data generation and reporting provided by this clinical decision support system increased the breadth of data that can now be accessed electronically. A retrospective chart review was conducted for all patients admitted for delivery in the obstetric unit at two acute care sites of Atlantic Health between January 1, 2008 and December 31, 2008.
Pamela S. Mellin, RN, MSN, APNC, Labor & Delivery, Atlantic Health, Morristown Memorial Hospital, Morristown, NJ
Donna T. Poplawski, RNC,
Results During the ¢rst quarter of 2008, prior to the implementation of the simulations, patients were administered antihypertensive medication for a systolic blood pressure greater than 180 or 100 mm Hg diastolic 23% of the time at Site A and 39% of the time at Site B. During the fourth quarter, antihypertensive medications were administered for a systolic blood pressure greater than 180 or 100 mm Hg diastolic 85.7% of the time at Site A and 60% of the time at Site B. This illustrates an increasing trend of administration of antihypertensive medication to patients experiencing hypertension.
MSN, NP, Labor & Delivery, Atlantic Health, Morristown Memorial Hospital, Morristown, NJ
Professional Issues
Discussion/Conclusions The implementation of obstetric simulations speci¢c to hypertension in pregnancy increased the appropriate administration of antihypertensive medication to patients experiencing signi¢cant hypertension. Results were limited by sample size. Atlantic Health will continue to collect data to determine if this trend continues. Repeating this study in other settings should be considered.
REFERENCES DeVita, M., Schaefer, J., Lutz, J., Wang, H., & Dongill, T. (2005). Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Quality and Safety in Healthcare, 14, 326-331. Reznek, M., Smith-Coggins, R., Howard, S., Kivan, K., Harter, P., Sowby, Y., et al. (2003). Emergency medicine crisis resource management: Pilot
Methods The implementation of an electronic medical documentation system that allowed for systematic data
S68
study of a simulation-based crisis management course for emergency medicine. Academic Emergency Medicine, 10(4), 386-389.
JOGNN, 39, S48-S84; 2010. DOI: 10.1111/j.1552-6909.2010.01121.x
http://jognn.awhonn.org
Does Simulation Team Training in Obstetrics Make a Difference? Poster Presentation Background he simulation of high-risk situations to promote learning and improve performance is not a new concept. The aviation industry is a well-known example of this. Pilots must test and train in £ight simulators on a regular basis (Reznek et al., 2003). Nursing students train in skill labs prior to actual patient care experiences. Anesthesia and Emergency Departments are using simulation training to improve performance in emergency situations (DeVita, Schaefer, Lutz, Wang, & Dongill, 2005). An obstetric simulation program promotes a rapid and organized response to these emergent situations. The Obstetric Quality and Safety Team at our hospital decided that obstetric simulations would be the best way to combine emergency drills, multidisciplinary team building, and improved communication. Obstetric emergency simulation drills were conducted at the obstetric units of both Atlantic Health hospitals in 2008. The two sites include a regional perinatal center and a perinatal intensive center. The combined total number of annual deliveries for both sites was 6,300. All simulations utilized the same scenario and were facilitated by the same personnel to provide continuity. Simulation of a patient presenting in hypertensive crisis included at least one primary care provider and two or more nurses. During the simulation experience, the use of antihypertensive and anticonvulsant medication administration was reviewed. Participants included 95% of obstetric nurses, 93% of obstetric hospitalists, and 63.5% of private attending obstetricians and certi¢ed nurse midwives at both hospital sites. The objective was to determine if the implementation of obstetric simulations speci¢c to hypertension in pregnancy would have an impact on the care of patients.
T
collection before and after obstetric simulation was introduced during the second quarter of 2008. The data generation and reporting provided by this clinical decision support system increased the breadth of data that can now be accessed electronically. A retrospective chart review was conducted for all patients admitted for delivery in the obstetric unit at two acute care sites of Atlantic Health between January 1, 2008 and December 31, 2008.
Pamela S. Mellin, RN, MSN, APNC, Labor & Delivery, Atlantic Health, Morristown Memorial Hospital, Morristown, NJ
Donna T. Poplawski, RNC,
Results During the ¢rst quarter of 2008, prior to the implementation of the simulations, patients were administered antihypertensive medication for a systolic blood pressure greater than 180 or 100 mm Hg diastolic 23% of the time at Site A and 39% of the time at Site B. During the fourth quarter, antihypertensive medications were administered for a systolic blood pressure greater than 180 or 100 mm Hg diastolic 85.7% of the time at Site A and 60% of the time at Site B. This illustrates an increasing trend of administration of antihypertensive medication to patients experiencing hypertension.
MSN, NP, Labor & Delivery, Atlantic Health, Morristown Memorial Hospital, Morristown, NJ
Professional Issues
Discussion/Conclusions The implementation of obstetric simulations speci¢c to hypertension in pregnancy increased the appropriate administration of antihypertensive medication to patients experiencing signi¢cant hypertension. Results were limited by sample size. Atlantic Health will continue to collect data to determine if this trend continues. Repeating this study in other settings should be considered.
REFERENCES DeVita, M., Schaefer, J., Lutz, J., Wang, H., & Dongill, T. (2005). Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Quality and Safety in Healthcare, 14, 326-331. Reznek, M., Smith-Coggins, R., Howard, S., Kivan, K., Harter, P., Sowby, Y., et al. (2003). Emergency medicine crisis resource management: Pilot
Methods The implementation of an electronic medical documentation system that allowed for systematic data
S68
study of a simulation-based crisis management course for emergency medicine. Academic Emergency Medicine, 10(4), 386-389.
JOGNN, 39, S48-S84; 2010. DOI: 10.1111/j.1552-6909.2010.01121.x
http://jognn.awhonn.org