Lights, Camera, Hemorrhage: Using Creative Learning Strategies to Engage Nurses

Purpose for the program:

Postpartum hemorrhage (PPH) is the number one killer of women in the postpartum period despite the fact that the United States spends more on healthcare than any other country.  The need for education on PPH identification and management in our department was recognized due to hiring a number of nurses new to specialty.  Communication issues between labor and delivery and the blood bank as well as confusion in ordering blood products following the implementation of Computerized Provider Order Entry were also identified.  A final issue was inconsistency in nurses' ability to recognize and respond to PPH in a coordinated manner.

Proposed change:

In order to reduce mortality and morbidity due to PPH, the labor and delivery Nurse Practice Council (NPC) developed and presented two simulation scenarios.  The first depicted common deficits in knowledge, skills, and communication leading to denial and delay while the second demonstrated best practices.

Implementation, outcomes and evaluation:

The Nurse Practice Council developed two scenarios depicting PPH.  Night shift chose a scenario showing denial of signs and symptoms of PPH, delay in management, and poor communication with physician, team members, and patient/family.  Day shift chose a scenario demonstrating best practices.  Each group recruited actors and developed their script in collaboration with the educator, unit medical director, anesthetist, and the blood bank educator.  The educator worked with the NPC to develop skill stations which reinforced objectives: no denial, no delay, and weigh blood loss.

Forty members of the department attended the presentation.  Attendees were actively involved in debriefing following each scenario and participated in the skill stations.  The research department provided breakfast and paid for nurses to attend.

Nurse interviews three months following the event described the following changes: increased use of the PPH cart, consistent weighing of blood loss, articulation of risk factors for PPH during shift huddles, and an increase in critical thinking.  Most importantly, nurses had clear role expectations, which has improved teamwork during a PPH.

Implications for nursing practice:

Engagement of direct care nurses in teaching each other is an effective method for changing practice to align with current recommendations for eliminating preventable deaths from PPH.  Active learning, including simulation, with adequate debriefing provides education in a safe environment.  The hospital has applied to participate in the Florida Perinatal Quality Collaborative's quality improvement initiative for obstetric hemorrhage management to assist us in achieving this goal. 

Keywords:

postpartum hemorrhage, skill stations, simulation, debriefing