Check One, Check Two, Check Three.........................Implementation of a Shoulder Dystocia Checklist in the Labor & Delivery Unit

Purpose for the program:

Shoulder dystocia is an obstetrical emergency that requires teamwork, effective communication and collaborative documentation.  The labor & delivery unit is an area of high liability.  The shoulder dysotcia checklist was designed to assist staff with management and documentation, thus improving patient safety.  

Proposed change:

The goal was to implement a shoulder dysotocia checklist to improve standardized management and collaborative documentation, thereby enhancing maternal and neonatal outcomes. 

Implementation, outcomes and evaluation:

The nurse manager, clinical educator, and a physician champion developed a checklist.   It was introduced to labor and delivery nurses at education days so they had the opportunity to trial the tool.  Staff provided feedback and the checklist was revised using their suggestions.  The checklist is placed in every L&D room in a specific location next to the baby warmer.  During a shoulder dysotocia, staff calls for help and the checklist is immediately implemented to provide standardized approach to management and collaborative documentation.  The checklist is used as a worksheet and not a permanent part of the medical record.  Post delivery, the team (L&D RN, obstetrician, CNM, NICU RN) uses the checklist to collaboratively document staff arrival times, maneuvers, and patient response to maneuvers.  The checklist was trialed with positive feedback.  The nurses had a vested interest since they assisted with revisions.  The checklist has been adopted system-wide.  The medical record shows improved compliance with standardized management & documentation consistency during shoulder dystocia emergencies.  In addition, nurses have reported increased confidence with their roles and responsibilities during this critical event

Implications for nursing practice:

Risk factors for shoulder dystocia may be present, but shoulder dystocia cannot be predicted or prevented.  Therefore, it is imperative that shoulder dystocia training, and simulation drills be a focus of ongoing education on the labor and delivery unit.   The shoulder dystocia checklist is a valuable tool used to guide management and collaborative documentation during this emergency situation. 

Keywords: Shoulder dystocia checklist