Purpose for the program:  This innovative safety program incorporates a multidisciplinary approach to team debriefing and high fidelity simulation-based training during a simulated critical event (shoulder dystocia).  This simulation program includes all providers (physicians, midwives, nurses and residents) associated with our obstetric unit and reinforces the concept of patient safety through practiced communication and teamwork.

 Proposed change: Annually each simulation participant will be given the chance to apply their previously learned TeamSTEPPS knowledge and skills to a critical patient scenario.  In turn this simulation program will be successful in establishing an effective approach for all disciplines with each patient encounter.

 Implementation, outcomes and evaluation:

Several years ago MCIC Vermont, Inc., our hospital’s risk retention group, developed the position of a patient safety nurse (PSN).  The PSN not only works as a patient safety advocate, but as a team training clinical nurse specialist through several MCIC driven initiatives.  Among these initiatives are TeamSTEPPS team training and simulation.

Each member of our health team must attend one initial 4 hour TeamSTEPPS class shortly after starting clinical work within our obstetric unit.  This course highlights our government’s Agency for Healthcare Research and Quality’s (AHRQ) TeamSTEPPS approach to teamwork and communication. Our simulation program was introduced not only for skills based training, but to reinforce and practice/apply interdisciplinary teamwork and communication taught within this TeamSTEPPS course.  Each attending physician, midwife, registered nurse and resident must attend at least one simulation annually to sustain their skills. 

It is expected that our unit’s safety culture will continue to show growth.  This has been shown by a significant reduction in adverse outcomes. Also, an evaluation tool is anonymously completed by all participants after completing each high fidelity simulation.  So far all responses have been very positive.

In addition, every 18 months we measure our culture of safety by administering Sexton’s, Safety Attitudes Questionnaire (SAT). All disciplines practicing within our obstetric participate with this research tool.  So far the teamwork and safety scores have steadily risen reflecting a positive attitude toward our simulation program as well as other initiatives.

Implications for nursing practice:  

Professional nursing’s responsibility to partnership with effective communication, collaboration, and teamwork is central to professional nursing.  All are crucial within the clinical settings as well as bringing research based, quality care to the bedside holding those patients who depend on us.

Keywords: Adverse events, perinatal safety nurse, simulation, team training, communication, safety attitude questionnaire