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Simulation of CriticalObstetric Events in aCommunity Hospital No Funding No Problem Cynthia Hartman BSN RN C EFM Simulation Coordinator.Deborah Jones BSN RNC OB C EFM Director of Obstetrics Objectives Identify the role of simulation in the management ofhigh risk low frequency obstetric events Describe strategies to provide robust simulation.experiences despite limited financial resources Evaluate the effectiveness of simulation in improvingteam performance Who we are FF Thompson Hospital 113 beds.Canandaigua NYMagnet Designated in 2004 twice re designated Joint Commission certified as an Advanced Center ofExcellence for Perinatal Care in 2016Rated by Becker Healthcare in the top 150 places to.work in healthcare three years in a row Some of our clinical team How and why did this journey begin We recognized that patients don t come to usexpecting mediocrity Our customers our insurers .and our team colleagues all expect that we arecompetent to provide high quality care in allsituations In community hospitals we are particularlyvulnerable to high risk low frequency events such.as shoulder dystocia maternal hemorrhage andemergency cesarean delivery Research shows that simulation presents an opportunity to practice criticalevent management and to improve team performance in a safe setting Options for event training include . Demonstration CDs You Tube Simulation Laboratories universities academic medical centers On site simulation training What are the potential barriers to.establishment of an on site training program Physical resources simulators patientcare equipment space for training Lack of buy in from staff and providers this needs to be all hands on deck . Trained staff to provide scenariodevelopment and de briefing Administrative support for time and What are the benefits of a home grown program We can simulate within our own reality. We will choose objectives that aretailored to the needs of our staff andreflect the circumstances of ourpractice and our population We know our staff their histories and.their vulnerabilities What do you need to get started This is a deal breaker it is essential to have atrainer who has enthusiasm empathy curiosity who is known and trusted by staff.and emotionally mature enough to conduct de You need support from Administration toapprove preparation and training time andsupport the purchase of necessary resources Ancillary services support Will RT participate.in some scenarios Will you involve a RapidResponse Team Providers this will not be effective without theirparticipation The entire team must engage What else do you need to get started . Space for scenario and de briefing A camera person Simulator actor Observers are a plus especially from differentdisciplines. Reasonable objectives A super sexy scenario around a clinical situationthat everyone would like to manage better andthat scares people at least a little simulation. How did the program unfold Carrie developed a clinical scenario andcoached the actor during 2 practice She contacted the providers offices toestablish one hour training times that.would work with their schedules She posted those times for nurses to sign She invited a few observers fromAdministration and Quality She arranged for space and a camera. How did the program unfold part 2 Typically aim for 3 minutes of de briefingfor each minute of scenario The scenario could be no more than 7 10minutes to allow 21 30 minutes of de brief. Have participants choose their roles Run scenario Ideally move away from the clinical setting to review video and de brief De briefing is where the learning occurs .The video is reviewed only as it relates tothe objectives not to individualperformance A unique aspect of our program is the low fidelity in the moment realistic depiction of the.emergency We are not in a laboratory We are ina labor room with an actor who looks and soundslike a real patient This was quite an experience We had invitedpeople to each simulation to be observers Some.of them became tearful because they were socaught up in the emotion of the situation Theysaid in the de briefing that they were worriedabout our actor and her baby and wanted to helpus take care of them That is the power of low .fidelity simulation with live actors David Gaba a simulation expert fromStanford describes the essence of our Simulation is not a technology it is atechnique that replicates substantial.aspects of the real world in a fullyinteractive manner Immersive clinicalscenarios with live actors must focus onteamwork and not get sidetracked ontechnical skills . How did the simulation translate into practice What lessons did we learn Someone has to be the team leader For shoulderdystocia the provider is the captain of the ship anddirects all other staff No one else speaks to the patient . A protocol was developed on paper to record events andmaneuvers are later transcribed into the EMR Roles are clearly defined Techs are a valuable resourceto help with McRoberts maneuver Labor nurse performssuprapubic pressure at the direction of the provider . Baby nurse is responsible for timing recording andcalling out times Provider calls out invisible maneuvers A simple de briefing is conducted after every real event What lessons did we learn part 2 . Online education was required and willbe repeated every two years Carrie maintains a library binder withobjectives and de briefing reports fromall simulation experiences . If trends were to be identified theywould be communicated up to Qualityand Safety All cases are reviewed by Protocols serve to eliminate minimizeanxiety and enhance team.In order to illustrate the simulation development and implementation process we focused today on shoulder dystocia However we have also run simulationsfor maternal hemorrhage and emergent cesarean deliveries How did we do Shoulder Dystocia and Emergent c sections Role identification gives everyone a job No one has to.worry if critical tasks are being completed Voices are not raised Situation is quiet and appears calm Leader is designated and directs the team Decreased Decision to Incision timeMaternal Hemorrhage . Medication hemorrhage kit in the PYXIS goes to thebedside for at risk moms as delivery becomes imminent Toolbox goes to the bedside tamponade balloon supplies curette ring forceps Blood loss is quantified by weighing pads. Sustaining the achievement For emergent c sections the roles of all personnelare posted in the staffbathroom . Use of the ShoulderDystocia worksheetensures accuratedocumentation of timesand maneuvers . De briefing after eachevent reiterates properprocesses and sustainsimprovement Quality review provides.feedback to all What are the costs Simulator numerous choices out there Low techdevices can be found for 500 1 000 Many grantopportunities are available for equipment . Trainer education again many programs outthere URMC was 500 for a one week program Staff time one hour per nurse and tech times thenumber of personnel Prep time for trainer and actor . Total less than 3 000 to start up Your equipment and coordinator training are one time expenses Recurrent expenses are personneltime only Questions .deborah jones thompsonhealth o... 585 396 6262This is a deal-breaker â€“ it is essential to have a trainer who has enthusiasm, empathy, curiosity, who is known and trusted by staff and emotionally mature enough to conduct de-briefing. You need support from Administration to approve preparation and training time, and support the purchase of necessary resources. Ancillary services support.