•    Purpose for the program: The Special Delivery Unit (SDU) in the Children’s Hospital of Philadelphia is a unit designed to perform fetal surgery and deliver fetuses with known anomalies. Some challenges for the staff are maintaining obstetric emergency competencies due to low volume, and learning to run adult emergencies within a Children’s Hospital. The purpose was to provide the interdisciplinary staff with realistic OB emergency situations in order to identify educational opportunities using simulation and debriefing and to identify barriers to providing appropriate care. This learning modality was selected so that staff could practice in a team environment which best portrays an obstetric emergency. 

 

•    Proposed change: The proposed change was using multidisciplinary simulation for team education rather than the annual Obstetric competencies education day in a lecture format for nurses.  In this change, Physicians, Midwives and Nurses would be working together as a team focusing on team dynamics as well as clinical objectives.

 

•    Implementation, outcomes and evaluation: The simulation program was implemented by creating a multidisciplinary planning team, in coordination with the hospital simulation team, to prioritize the highest risk, low volume Obstetric emergencies. To select these topics, the group took into consideration information from risk management, joint commission recommendations, and problem-prone areas. Scenarios were created combining that information with the simulation model capabilities. Time was scheduled to ensure that all members of the Obstetric team were able to attend one simulation. Each simulation lasted four hours and included the simulation of a Maternal Code, Shoulder Dystocia, Post-Partum Hemorrhage, and Fire in the Operating Room. After completing the simulations, staff feedback and evaluations were reviewed.  Themes identified were: the need for more frequent simulations and easier access to supplies needed during a post-partum hemorrhage. As a result simulations are now being planned for twice a year and a post-partum hemorrhage cart was created.

 

•    Implications for nursing practice: There are many positive implications for using simulation as a learning modality. It allows education of not only clinical skill, but also team communication skills that are vitally important in an emergency. Additional implications are the ability to identify process issues and make changes that could quickly impact practice. Simulation also offers the opportunity to practice skills in a non-threatening atmosphere where questioning practice is an expectation and making mistakes has no adverse effects on the patient.

•    Keywords: Simulation, obstetric emergency, team training