Buffy's Bad Day: A Progressive Format For Annual Interdisciplinary Education Featuring High Risk Obstetric Simulation

Purpose for the program: Present a format that promotes the effective planning and facilitation of multiple simulation topics in obstetric complications and teamwork training in a structured prescheduled session.

Proposed change: Our unit is planning structured annual review of high risk, low frequency clinical events in labor and delivery including shoulder dystocia and postpartum hemorrhage using this progressive format to optimize staff and facilitator time and supply and space resources.

Implementation, outcomes and evaluation: After the identification of the topics to be presented, simulation scenarios are developed that allow progressive development of the "patient's" symptomatology. Staff were assigned and scheduled in small groups for these education days, ensuring that implementation wasn't dependent on unit workflows. This also ensured that all staff received an opportunity to participate. This results in efficient use of space, time, and resources as the stem of each scenario remains consistent and the participants all have first hand knowledge of the preceding events.  The scenarios built upon each other in situ, utilizing the same labor room and cesarean suite. Debriefing occurred after each scenario segment, allowing focused reflection and discussion to occur prior to the next topic.  TeamSTEPPS principles of effective teamwork and communication were stressed along with reviewing clinical responses. The evaluations completed by participants of our sessions rated  the sessions very highly in terms of organization, being able to implement the ideas/activities, and being a beneficial use of time: overall 4.96/5.0.

Implications for nursing practice: This model proposes an efficient use of resources in the planning and execution of simulation training for staff and providers practicing in a high risk clinical area. Regular practice of clinical and medical teamwork behaviors can improve responses and positively impact outcomes of women and infants in the labor and delivery setting. 

Keywords: simulation, teamwork, shoulder dystocia, postpartum hemorrhage, drill