Getting to Know YOU. Objectives As a Result of This Program I am Able to: 2/9/2015. Simulation in Obstetrics. Dr. Renee Bobrowski

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1 Simulation in Obstetrics Dr. Renee Bobrowski Debbie Ketchum, BSN, RNC, MAOM Kelly Wilson, RNC Getting to Know YOU ow many of you are actively involved in OB simulation? ow many of you lead teams for simulation? ow many of you have been to other conferences regarding this subject? ow many of you have had to be the OB patient for Simulation? Objectives As a Result of This Program I am Able to: Understand the purpose and benefits of Medical Simulation in Obstetrics-The Why. Define simulation to leaders and providers to gain by-in and support for obstetrical simulation-the What. Gain knowledge of how to start an obstetric or other medical simulation team in my facility- The ow. 1

2 T E W Y Why do we need a new training method? Suburban ospital Staff #s Obstetricians 81 L&D Nurses 50 Anesthesiologists 16 NNPs 12 Scrub Techs 14 CRNAs 35 ow many C/S teams are possible with these staff numbers? 381 Million! A Team of Exper t s Is not An EXPERT TEAM! 2

3 The Number One Risk to Safety? Variability! Additional Benefits of Simulation Cost Avoidance Decrease adverse outcomes Risk reduction both in severity & frequency of payouts Avoidance of future claims Malpractice Premium reduction Cost Savings Correct System Issues Improve response time -OR set-up, turnover (increased productivity) Increase staff productivity, competency, confidence and satisfaction Decrease RN turn over, sick calls,use of travelers (orientation $30,000 $60,000) T E W A T What is Medical Simulation Use of a device or series of devices along with clinical personnel, To emulate a real patient care situation or environment For the purpose of training and evaluation It is not just technology It is a proven technique to train healthcare personnel without risk to the patient or members of the clinical team Provides the opportunity for clinicians to Practice routine as well as low incidence, high risk events 3

4 Simulation Records of its use in 1600s for teaching midwives Basket and leather fragments in shape of a pelvis Used today in a variety of industries Airline industry has led the way Substantial decline in accidents from 1980s onward Simulation Simulation allows us to expose and correct weaknesses, vulnerabilities and the potential for error before it causes harm Simulation Provides opportunities Gain skills when real world training is expensive or dangerous Experience Refine and refresh skills Currently used in multiple disciplines Anesthesia General and trauma surgery Emergency medicine Obstetrics and pediatrics And the list grows. 4

5 Simulation Training Opportunity to practice: Technical skills ands on procedures deliver the baby, give medication Cognitive skills Critical thinking Decision making Behavioral skills Interpersonal interactions It is a team sport!! Simulation in Obstetrics Endless possibilities Low-frequency, high acuity events are perfect for simulation Eclampsia, Shoulder dystocia, ypertensive Crisis But it is equally effective for common, everyday events Ideally multidisciplinary team performing drills Include anesthesia, neonatology/peds staff and providers Combine disciplines as with Obstetric Trauma cases Most important is post-scenario debriefing Participants explain, analyze and synthesize their actions Possible Perinatal Scenarios Maternal STAT C/Section Shoulder dystocia Difficult maternal airway PP emorrhage Amniotic fluid embolism igh regional block Seizure Anaphylaxis Fire in the OR D &C s Neonatal Neonatal resuscitation ypovolemia Meconium Premature birth Fetal anomalies Neural tube defect Diaphragmatic hernia Abdominal wall defect 5

6 What Simulation Does Best Provides a safe environment Mistakes are tolerated Appropriate responses learned and then practiced Identify system-based issues and staff responses that can be improved in response to critical clinical events Impact of simulation training can be monitored by tracking clinical outcomes Reduce malpractice premiums through incentive programs in risk-reduction What Simulation Does Best Benefit communities through education of paramedics, EMTs and critical access hospitals, elps build confidence, communication techniques, and skills in our newer staff T E O W Core group of committed staff and providers Need a champion! (Physician/Provider and Nurse) It takes time to develop and run a program Need administrative support and that includes financial! You will see a return in investment e.g. decreased insurance premiums, staff retention Focus on the simple things first Think about clinical issues that have been challenging Near misses Consider processes that could use improvement Time it takes to get a CS team together and patient to OR for stat CS 6

7 Just Culture Principles of risk Accountability Focus on Behavior MANAGE ERROR In Situ Simulation Experiential learning Application Test for gaps ID ERROR igh Reliability TeamSTEPPS Define the team Use the tools Coach to sustain MITIGATE ERROR Riley, W, Davis, S, Miller, K, Mccullough, M. A Model for developing highreliability teams. Journal of Nursing Management. July 2010 p Team Strategies and Tools to Enhance Performance and Patient Safety Evidence based Improves outcomes Increases satisfaction Decreases harm SKILLS Situational Awareness Standardized Language (ex: SBAR) Closed-Loop Communication Shared Mental Model US TOOLS SBAR NICD Language Code C-section Stop the line 7

8 Write up a short script for the scenario Provide a Brief with the Ground Rules of Safety/Trust Let the group manage the situation and play it out Allow mistakes to be made No coaching just give clinical information to keep the simulation moving e.g. patient response to a medication or procedure ave specific tasks in mind that should be accomplished Medical procedure, communication, staff interaction Review what was and was not done when you debrief Don t need fancy stuff Do the simulation where the care occurs or improvement is needed L&D, the OR, the ED Can use staff to act as patients Appropriate size doll for term and preterm babies Neonatal resuscitation Video tape for debriefing recommended Who is Noelle? Variety of mannequins emi-pelvis Noelle Baby al Clinical scenarios programmed into the simulator Noelle speaks Vital signs and fetal heart rate tracing change as the scenario unfolds Perform cervical exams, follow labor progress and deliver baby Breech delivery Shoulder dystocia 8

9 The Debrief The Debrief is the most important aspect of Simulation! We run scenarios just as an excuse to debrief! -David Gaba Debriefing is Where the Learning appens 1.What went well and why? 2.What could have gone better and why? 3.What would I do differently next time? Simulation Debrief Review the Types of Comments Communication and Teamwork Process Improvement Simisms Clinical Care Review Individual Communication & Teamwork Skills Situational Awareness ME Standardized Language (ex: SBAR) Closed-Loop Communication Shared Mental Model US YOU 9

10 Questions? Time for Fun! 10