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Developing a culture of safety within healthcare has become a prime focus since the Institute of Medicine (IOM) released its report, To Err is Human (1999). The report defines the magnitude of errors in healthcare and outlines potential areas for change. The IOM reports, “Improvements in safety do not occur unless there is a commitment by top management and an overt, clearly defined effort on the part of all personnel and managers.”  The establishment of interdisciplinary team training programs including the use of simulation for trainees and experienced practitioners was an IOM recommendation. The challenge this writer assumed, upon promotion to a newly created position of Perinatal Clinical Nurse Specialist in 2008, was to initiate team training to address safety issues in perinatal care. The creation and implementation of educational programs that enhance perinatal safety have been implemented within the last 18 months. The initiatives include simulated drills for interdisciplinary team training, mandatory fetal heart rate monitoring courses utilizing the Association of Women’s Health, Obstetric and Neonatal Nursing’s (AWHONN) Intermediate Course, standardizing our oxytocin policy and SBAR communication.

Upon completion of requirements as an AWHONN fetal heart monitoring instructor, along with the two managers of Labor and Delivery, we initiated mandatory education of all MCH nurses who monitor the perinatal patient. The initiative was begun in September of 2008. By the end of 2009 all perinatal nurses will have completed the AWHONN Intermediate Course. A bimonthly, mandatory electronic fetal monitoring tracing review is an exercise given to the Mother Baby Unit staff to increase their exposure and competency. Private attending obstetricians are required to attend a mandatory fetal monitoring course as well. Our involvement as FHM instructors has been integral in the administration and teaching of that training course.

The Obstetric simulation program in our institution was commenced in the spring of 2008. Hospital administration purchased an obstetric simulator. This writer was sent, by the hospital, to the 2008 AWHONN convention where I attended a preconference on simulation training. Upon my return, an interdisciplinary team was convened to aide in the planning and piloting of an OB simulation program. To date we have had six interdisciplinary simulations. Several drills combined different critical events such as shoulder dystocia, ante partum and postpartum hemorrhage, neonatal resuscitation and emergency cesarean section.

After review of current literature, a team of labor nurses, the perinatal CNS, and an obstetrician convened to revise our oxytocin policy. We adopted a standardized pre oxytocin checklist and a low dose oxytocin protocol for labor induction and augmentation.

Situation, Background, Assessment, and Recommendation (SBAR) is a form of communication that has been a focus of national patient safety goals. SBAR has been taught in our fetal monitoring courses. Worksheets for handoffs have been revised to include the SBAR format.

The response to the perinatal safety initiatives has been overwhelmingly positive. The poster will provide details of the initiatives instituted at this organization.