Who Wants to Play with Dolls? Implementing a Collaborative OB Simulation Program to Improve Patient Safety

Purpose for the program: Obstetric emergencies are low volume but extremely high risk with potentially devastating outcomes.  The purpose of this program is to provide a more structured approach to simulation training in the obstetric department and improve patient safety through real time feedback. The Mobile Obstetric Emergency Simulator (MOES) provides us the opportunity to simulate in the actual location of the event compared to an offsite location.  In addition, this program results in decreased patient safety events as well as enhanced teamwork among nurses and physicians.

Proposed change: All Physicians and Nurses particpate in simulation training utilizing the MOES system led by a team of physicians and nurses working collaboratively.  The MOES system gives us the ability to transfer the training simulator to an actual patient room where simulation of specific obstetric emergencies can then be played out in a more realistic environment.  This program brings the simulation directly to the bedside unannounced and unscheduled further enhancing a realistic emergency environment.  The program consists of case scenarios that specifically involve high risk situations to include:  post partum hemorrhage, cord prolapse, shoulder dystocia and maternal code. 

Implementation, outcomes and evaluation: The MOES system includes a manequin (NOELLE) as well as a mobile electronic cart that houses a monitor that can be programed for real time viewing of maternal and fetal vital signs.  Each participant  completes an online education module prior to attending the course.  Once in the course, each participant then participates in "hands on" skills stations prior to the actual simulation event.  Following the simulation, a debriefing takes place where the participants submit feedback through an audience response system. Outcomes include decreased adverse events, enhanced collaboration and teamwork based on the Safety Attitudes Questionnaire.  Outcomes also include increased physician and nurse satisfaction. In addition, policy changes and additional training needs are identified during the simulation session.  Results are communicated throughout the division.

 Implications for nursing practice: The Staff members who participate in the simulation program have demonstrated more effective communication and collaboration. The nurses have gained increased confidence in responding to unexpected emergencies related to maternal/fetal complications. 

Keywords: simulation, MOES, communication, patient safety