OB department excels at maternal emergency preparedness

June 25, 2018 Providence Health Team

Program uses manikin to simulate emergencies that can occur during the birth process.

The training can build teamwork and communication between medical staff and departments.

The ability to work together can prevent delays that could be harmful during an emergency.

The birth of a baby is a joyous occasion, but if something goes wrong during labor and delivery, it can be dangerous for mother and baby. Preparation and training for emergency situations can make a crucial — in some cases, life-saving — difference, which is why the Interprofessional Perinatal Simulation Program at Providence Holy Cross Medical Center in Mission Hills, CA is so important.

For the past two years, the program has been supported by a grant from UniHealth Foundation, a nonprofit philanthropic organization whose mission is to support and facilitate activities that significantly improve the health and well-being of individuals and communities within its service area. The program allows physicians, nurses and health care staff to hone how they respond during life-threatening emergencies, using a maternal manikin named “Victoria” that is manufactured by Gaumard Scientific. The first two training sessions simulated postpartum hemorrhage and preeclampsia situations; the most recent one in May focused on maternal code blue emergencies caused by cardiac arrest.

Julie Masson, RN, the perinatal simulation educator overseeing the program, loves what it has done to enhance morale and teamwork, as well as streamline procedures. “It has brought the departments together. Postpartum, NICU and labor and delivery all have to work together and communicate effectively,” Masson says. “We have seen firsthand how simulations uncover gaps and reveal areas for improvement. Our hard-working simulation team, along with our motivated staff and leadership, are willing to work with us to make lasting, sustainable changes that can make the care we provide safer and more effective.”

When the simulation program began, the physicians and nurses were unsure of what to expect, Masson says, but they now request more frequent training sessions. It has made a big difference; Masson says that in evaluations and reports she has compiled, the medical personnel say they feel the process has improved communication, collaboration and teamwork.

“Some staff have mentioned that they previously felt intimidated to speak up to physicians in emergencies, but simulations have leveled the playing field and helped them feel more comfortable because they are training together,” she says. “Staff say it emphasizes the importance of communication and coordination during an emergency. One nurse said she felt doctors were more like equals than superiors, and others have said it’s by far the best training they’ve ever participated in.”

Because simulations can so closely mimic real-life health crises and take place in the hospital environment, they are invaluable tools for learning and ensuring everything is running as it should.  “We like to do the simulations in the department because that makes it much more realistic for the staff, and they get to use their own supplies and equipment. We’ve been able to make so many positive changes because of our simulations. Staff feel empowered when they see these changes come to fruition. They can see that they are making a difference and that their voice can make a change.” 

With each simulation, the team looks at the objectives it wants to achieve — those can include patient care, teamwork, communication, roles, medication regimens, use of equipment and other best practices. “We use cameras in our simulations because we videotape for debriefing so that the staff can go back to it. We write scenarios that are relevant to our hospital and use best practices. We always begin with a pre-briefing and remind staff how the manikin works. This is followed by a 10-minute to 15-minute scenario and a debriefing with one of our nurses and one of our physician faculty.”

This debriefing is where the magic happens, Masson says. “It’s where people talk and learn; it’s an amazing process. In debriefing, we learn what needs to be done, what needs to be changed, what can be better and how to be safer. Some true ‘aha!’ moments can occur during this time.  We strive to make debriefing a part of our everyday culture because it has so many benefits.”

The staff can see firsthand how simulations have already benefited their department and their patients. “When we were conducting our postpartum hemorrhage simulations last year, we were able to revamp and update our hemorrhage carts, making two — one for postpartum and one for labor and delivery,” says Masson, who adds that the carts are aligned with the high standards set by the California Maternal Quality Care Collaborative.  “During the simulations, our staff were able to practice with the cart, becoming more familiar with supplies and where things are located. Real-life situations can sometimes mimic our simulation sessions, and this is when we can see the benefits of this type of training.  With these kinds of emergencies, the biggest problem is often delay. If you’re not training as a team, sometimes there can be delay if someone is not familiar with what to do or where supplies are located. High-quality training and practice through simulation puts everyone on the same page to know what to do so there’s no delay.”

If you’re expecting a baby, download the Circle by Providence app for free resources, classes, checklists and other tools to help guide you through every stage of pregnancy and child rearing, including a baby development tracker, checklists and health tips.

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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