Purpose for the program:     In 2009, Baltimore Washington Medical Center opened the Pascal Women’s Center (PWC) offering Maternal-Child service.  As the units were in its developmental phase, the management team and the unit’s Quality Team decided it would be beneficial to implement simulation training in the new OB unit to ensure that staff developed and maintained crisis skills.

 Proposed change: The group recognized required changes in patient outcomes and staff training.

Implementation, outcomes and evaluation: In December of 2010, PWC instituted their version of simulation training called TWIST, Teambuilding in Women’s Health Incorporating Simulation Training, which includes managing patients with shoulder dystocia, post-partum hemorrhage, prolapsed cord, and neonatal resuscitation.  During this training, clinical skills, crisis management processes and TeamSTEPPS tools were incorporated.  Each scenario was videotaped followed by a debriefing period.  The staff and facilitators identified areas of strength and developed a commitment to improve our processes of managing OB crises. 

The initial phase of simulation training inspired new ideas for continuing the TWIST program. The  leadership team felt crisis training makes a significant improvement in outcomes and staff readiness. According to HCHAPS surveys, perception of safety before institution of TWIST training was 79 % and after institution safety perceptions increased to 89%. Therefore, every month TWIST facilitators conduct an unannounced simulation training in which the staff engages in realistic scenarios to improve safety, processes and maternal-neonatal outcomes.

        One TWIST scenarios examined a newborn resuscitation on the mother-baby unit. Our goal was to not only review clinical skills of NRP but also examine the processes and resources for staff within the organization.  During this TWIST training the team was able to identify telecommunications failure to reach all essential OB and pediatric staff.  Another issue identified was a breakdown in the emergency call buttons requiring follow-up by facilities.  TWIST training enlightened the staff to clinical and operational breakdown. As a result, this scenario prepared staff clinically at preventing operational breakdowns that may have occurred in an actual emergency.

           Implications for nursing practice:   PWC is now involving different departments into our monthly training, which includes the Emergency Department, Blood Bank, EMS, and Laboratory.  Through the incorporation of these units, the goal is to optimize patient care and emergency responses. Focusing on patient safety and improving outcomes other units and organizations are recommended to TWIST.

Keywords: Simulation training, teamstepps, outcomes