To provide information on the EXIT procedure and to develop standards of care to ensure the multidisciplinary perioperative team provides excellent patient care during the EXIT (Ex Utero Intrapartum Treatment) procedure by using the TEAM approach:

          T-Multidisciplinary team using the latest technology

          E-Evidence based practice

          A-Utilization of AORN standards

          M-Highest quality of care for mother and infant

Proposed change:

Since the EXIT Procedure was a new procedure a plan of care need to be created.   Each procedure has a unique set of patient specific      clinical needs. The role of each multidisciplinary member needed to be defined.  Perioperative nurses collaborated with members of the multidisciplinary team to define the role of each member.  This included staff nurses from Labor and Delivery, Surgery and NICU (Neonatal Intensive Care Unit). There was also a need to develop clinical guidelines and protocols and to educate the staff. Pre procedure briefing and post procedure briefing planned.

Implementation, outcomes and evaluation:

1. A pre-procedure briefing was held 1-2 hours prior to the start of the procedure. 
2. All the representatives from each discipline were in attendance
3. A perioperative EXIT supply checklist was developed by the team for ensuring that all the necessary supplies were available at the time of the procedure.
4. Provided education to all members of the EXIT team regarding the pre-procedure checklist and how it is utilized and that continuing scrutiny of this checklist will be ongoing.

All the equipment was readily available for use during the actual procedure. Through the process of team building and education the perioperative team members had an increase understanding of each other team member’s role. A post procedure debriefing is held to review supplies used and add additional information as needed for future cases.

Implications for nursing practice:

Each EXIT procedure performed provides the opportunity to improve patient care and provide new information to our colleagues regarding our increased knowledge in this unique area.

Algorithm of care established:

Hystertomy, Fetal airway assessment, direct laryngoscope, airway suctioning, view of vocal cords, Rigid or Flexiable Broncoscope, Intubation or tracheostomy, application of pulse oximeter and fetal heart monitor or EKG.

Keywords:

EXIT, algorithm of care, multidisciplinary team members, EXIT checklist,