Improving Obstetrical Rapid Response Teams: Multidisciplinary Simulation Training Using the Plan-Do-Study_Act Cycle
Title: Improving Obstetrical Rapid Response Teams: Multidisciplinary Simulation Training Using the Plan-Do-Study_Act Cycle
- Implement a mass page alert system.
- Improve access to medication, equipment, and supplies.
- Instill use of the PDSA cycle into RRT decision-making process.
Ineffective teamwork and communication failures contribute to 70% of adverse obstetrical events. Citing a rise in maternal mortality, ACOG and the Joint Commission recommended creating obstetrical rapid response teams. These recommendations include utilizing drills to ensure competency during emergencies.
Our institution developed a rapid response team (RRT) of nurses, residents, attending physicians, and ancillary staff from obstetrics, neonatology, and anesthesiology.
We used the Plan-Do-Study-Act (PDSA) methodology to train RRT members to identify system and process barriers that impede effective emergency response. Changes, based on these observations, are trialed during live videotaped in situ simulations. If, after debriefing, the group deems the changes worthwhile, an action plan implementing the change is created. Changes are incorporated into obstetrical emergency protocols and reviewed at the next training session.
Proposed change:
The purpose of this innovative program was to train the OB RRT in PDSA cycle use during multidisciplinary simulation to achieve the following goals:
1) Identify the most common errors during obstetrical emergencies and reduce them by 50% in one year.
2) Increase number of rapid response calls by 50% in one year.
3) Decrease time from call to team response by 25% in one year.
Implementation, outcomes and evaluation:
Each multidisciplinary training session includes the following:
1) RRT lectured in one obstetrical emergency per session.
2) Videotaped live simulation on unit witnessed by entire RRT
3) RRT divides into small groups and use PDSA method to discuss needed changes/process improvements
4) Entire RRT debriefs on simulation/small group simulation results
5) Debrief action plan created based on group PDSA/simulation findings
6) PDSA changes trailed clinically by teams during real calls
7) Successful changes implemented and reviewed at next training session
Since implementation of the RRT we have:
1) Increased accessibility of equipment and supplies by 50% by creating RRT carts.
2) Increased accessibility to uterotonic medications by 50%.
3) Increased team response calls by 50%
4) Successfully implemented two mass alert communication systems.
5) Created and completed three group simulation
Implications for nursing practice:
Multidisciplinary PDSA cycle training creates objective team building and problem solving.
This gives providers ownership in change that directly impacts clinical care. PDSA simulation
training aids in 1) improving staff emergency preparedness, 2) identifying the most common
obstetrical emergency errors, and 3) creating evidence based protocols based on successful
PDSA change implementation.
Keywords: rapid response, PDSA, obstetrical emergency