The Joint Commission and the American Congress of Obstetricians and Gynecologists recommend using emergency drills/simulation to improve teamwork and communication.

Proposed change:   

High fidelity simulation can be expensive.  Since most obstetrical emergencies involve moving the patient, our multidisciplinary team determined the best method of implementing emergency drills was to use in situ simulation using a standardized patient.

Implementation, outcomes and evaluation:   

Participation in the monthly drills is mandatory for all labor and delivery staff and OB residents. Attendance is optional for private physicians.  Before the drill begins everyone is given a role card and there is a short presentation on safety, teamwork and communication.  The drill is videotaped followed by a debriefing session.

As a result of doing in situ drills many opportunities to implement change were discovered. The primary nurse wears a red hat which identifies her as the person to give the SBAR. The role of the charge nurse and physician in emergency situations were delineated.  Nurses have heightened awareness of how they can assist anesthesia. Nurses learned the importance of being able to work the operating room table. Oxygen masks are removed from the patient while she is being transported to the operating room. A nurse is designated to be a support person to the patient.  Problems with our wireless communication system were identified and fixed.  Equipment was purchased.

With more effective communication the noise level has decreased.  Communication between disciplines has improved and physicians and nurses state they work more effectively as a team. 

Implications for nursing practice:  

In Situ simulation using a standardized patient can create learning opportunities that result in more effective communication, improved teamwork, and the ability to identify issues related to the physical environment.

Keywords:

emergency drills

in situ simulation

standardized patient

practice change