Purpose for the program: Many organizations, such as The Joint Commission, the National Quality Forum, and the Accreditation Council for Graduate Medical Education, have cited the importance of teamwork in patient safety. At the University of Pennsylvania Health Sysytem, the incidence of shoulder dystocia was under-acknowledged and under-reported. This emergent, often unforeseen, complication can only be diagnosed during the delivery process as the fetal body negotiates the maternal pelvis. And as with many clinical emergencies, heightened levels of anxiety, role confusion, and miscommunication among caregivers often result.

Proposed change: As a risk reduction strategy, an interdisciplinary team recognized the need to create an evidenced-based, seamless, team approach to manage shoulder dystocia, called Managing the Obstetrical Emergency: Team Training in Labor and Delivery through Simulation which included multidisciplinary teams from two of the health system's hospitals. Implementing such a program using specific birth maneuvers and role clarity may decrease the incidence of associated shoulder dystocia injuries, improve communication, and increase the reporting and proper documentation of shoulder dystocia.

Implementation, outcomes and evaluation: The program includes interdisciplinary classes devoted to didactic presentations, case studies, simulation sessions using a high fidelity simulator, team training, communication, and role identification. A self-assessment tool is administered at the beginning of the didactic session and re-administered immediately following the session. The results of the self-assessment tool have demonstrated the improved knowledge and improved communications skills to effectively function as a team. To evaluate the participant's competency and application of knowledge, direct observational simulation sessions are conducted using case scenarios. These sessions are videotaped and immediately debriefed following the drill. In addition to the didactic and simulation sessions, practice drills are also conducted on the Labor and Delivery units. These drills provide the team with the opportunity to practice the interventions for a shoulder dystocia emergency in a non-emergent setting. In addition to the improved self assessment, team training has also possibly helped to increase nursing staff satisfaction as demonstrated by yearly NDNQI Nurisng Satisfaction Survey scores. And additional outcome of the team training initiative has been the reduction of brachial plexus injuries from 2008 to 2010.

Implications for nursing practice: As a result of the program, nurses are able to identify indicators which may preclude a shoulder dystocia, assist the provider in facilitating appropriate maneuvers to deliver the shoulder, and accurately document the event.

Keywords: Shoulder Dystocia, Team Training, Interdisciplinary