Shoulder Dystocia Safety Strategies: A Multidisciplinary Learning Experience

Purpose for the program:   Shoulder dystocia is an unpredictable and uncommon emergency with risks for serious injury to both mother and fetus.  High-reliability obstetric units prepare for these emergencies.  A pilot curriculum for the management of safe patient care practices for shoulder dystocia is presented.

Proposed change:   Evidence based guidelines exist for shoulder dystocia safe practices.  The challenge is to ensure these guidelines are applied to every patient, every time.  Effective teamwork is critical where individuals interact with other persons to perform their job.  We believe that a curriculum involving both a didactic and deliberate practice in shoulder dystocia will promote the non- technical human factors safety behaviors and the correct application of management interventions in a simulated shoulder dystocia. 

Implementation, outcomes and evaluation:   The didactic segment includes a pretest followed by five eLearning modules with posttests. This program reviews identification of risk factors associated with shoulder dystocia, knowledge of nursing and medical interventions, correct application of interventions and an introduction to selected TeamSTEPPS ( Team Strategies and Tools to Enhance Performance and Patient Safety) communication tools.  Data will be collected and stored on the eLearning management system for pre and post learning comparison. 

Completion of Shoulder Dystocia eLearning content will be a mandatory requirement prior to participation in a shoulder dystocia in-situ simulation.  Emphasis will be placed on team performance and communication and not technical skills. Knowledge and attitudes toward teamwork and safety will be evaluated using the TeamSTEPPS Teamwork Attitudes Questionnaire. 

Implications for nursing practice:   In a safe work environment employees are guided by their employer’s commitment to safety where each employee every time upholds their own safety standards and those of their co-workers.  In-situ simulation is used to help individual nurses learn how to become better team members during a shoulder dystocia which will enhance safe patient care and communication in both simulated and real world clinical environments.

Keywords: :  Shoulder Dystocia, Simulation, Teamwork