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Obstetric emergency drills

Angela K Shaddeau, Shad Deering
Shoulder dystocia is an unpredictable obstetric emergency that requires prompt interventions to ensure optimal outcomes. Proper technique is important but difficult to train given the urgent and critical clinical situation. Simulation training for shoulder dystocia allows providers at all levels to practice technical and teamwork skills in a no-risk environment. Programs utilizing simulation training for this emergency have consistently demonstrated improved performance both during practice drills and in actual patients with significantly decreased risks of fetal injury...
September 22, 2016: Clinical Obstetrics and Gynecology
Neil F Moran, Mergan Naidoo, Jagidesa Moodley
Training programmes to improve health worker skills in managing obstetric emergencies have been introduced in various countries with the aim of reducing maternal mortality through these interventions. In South Africa, based on an ongoing confidential enquiry system started in 1997, detailed information about maternal deaths is published in the form of regular 'Saving Mothers' reports. This article tracks the recommendations made in successive Saving Mothers reports with regard to emergency obstetric training, and it assesses the impact of these recommendations on reducing maternal mortality...
November 2015: Best Practice & Research. Clinical Obstetrics & Gynaecology
Meredith Green, Carla Rider, David Ratcliff, Barbara C Woodring
OBJECTIVE: To determine the effect of standardized education specific to maternal resuscitation on nurses' confidence and competence during obstetric emergencies and to determine the cost savings associated with the program. DESIGN: Pre- and postintervention surveys designed to measure perceived confidence and competence in resuscitation before and after Advanced Cardiac Life Support (ACLS) certification in combination with obstetric drills. SETTING: The project was conducted at a 12-bed labor and delivery, mother/baby unit in an acute care, community-based hospital in Northwest Arkansas...
September 2015: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
Charles A Ameh, Nynke van den Broek
An estimated 289,000 maternal deaths, 2.6 million stillbirths and 2.4 million newborn deaths occur globally each year, with the majority occurring around the time of childbirth. The medical and surgical interventions to prevent this loss of life are known, and most maternal and newborn deaths are in principle preventable. There is a need to build the capacity of health-care providers to recognize and manage complications during pregnancy, childbirth and the post-partum period. Skills-and-drills competency-based training in skilled birth attendance, emergency obstetric care and early newborn care (EmONC) is an approach that is successful in improving knowledge and skills...
November 2015: Best Practice & Research. Clinical Obstetrics & Gynaecology
V Bogne, C Kirkpatrick, Y Englert
UNLABELLED: To assess the value of simulation based training in the management of obstetric emergencies. METHOD: A search by keywords: obstetrics, gynecology, simulation, drills, emergency training restricted to randomized trials led to a selection of eight articles. RESULTS: Shoulder dystocia simulation unmasked deficiencies in performing Mc Robert maneuver in nearly 20% of doctors in training as well as ineffective and potentially harmful maneuver such as pressure on the uterine fundus...
November 2014: Revue Médicale de Bruxelles
Radha Pandian, Manisha Mathur, Deepak Mathur
Cardiac arrest in pregnancy is a rare but catastrophic obstetric emergency, with a quoted incidence of 1:20,000 pregnancies. Speedy multidisciplinary interventions are crucial for good maternal and foetal outcomes. A perimortem caesarean section (PMCS) initiated within 4 min of onset of cardiac arrest to minimise the effect of aortocaval compression on cardiopulmonary resuscitation (CPR) has been recommended as a key intervention, which is likely to improve survival of both mother and foetus. Sudden collapse is uncommon in pregnant women and their management is more challenging than in a non-pregnant patient...
April 2015: Archives of Gynecology and Obstetrics
(no author information available yet)
Patient care emergencies may occur at any time in any setting, particularly the inpatient setting. It is important that obstetrician-gynecologists prepare themselves by assessing potential emergencies, establishing early warning systems, designating specialized first responders, conducting emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. Having such systems in place may reduce or prevent the severity of medical emergencies.
March 2014: Obstetrics and Gynecology
Abha Singh, Lily Nandi
OBJECTIVE: To evaluate factors contributing to obstetric emergencies, analyze the fetomaternal outcome and role of obstetric drill in facing these emergencies effectively. MATERIAL AND METHOD: Out of 10,892 deliveries, a total of 520 women were included in this prospective study. Analysis of emergency obstetric conditions was done by evaluating incidence, various contributing factors, and fetomaternal outcome. Obstetric drill was conducted among residents repetitively...
June 2012: Journal of Obstetrics and Gynaecology of India
Mary Whelan
The Rotunda Hospital (Dublin) obstetric emergency training programme (RHOET) was designed, in 2008, to meet the ongoing education and training needs of the local multidisciplinary team. Prior to its implementation, senior midwives attended the advanced life support in obstetrics (ALSO) course, and many of the obstetricians attended the Management of obstetric emergencies and trauma (MOET) and/or ALSO courses. Attendance at these off site courses meant that the only opportunity for team training was the informal and ad hoc 'drills and skills' that took place in the birthing suite...
September 2012: Practising Midwife
S S Lipman, B Carvalho, S E Cohen, M L Druzin, K Daniels
OBJECTIVE: We documented time to key milestones and determined reasons for transport-related delays during simulated emergency cesarean. STUDY DESIGN: Prospective, observational investigation of delivery of care processes by multidisciplinary teams of obstetric providers on the labor and delivery unit at Lucile Packard Children's Hospital, Stanford, CA, USA, during 14 simulated uterine rupture scenarios. The primary outcome measure was the total time from recognition of the emergency (time zero) to that of surgical incision...
April 2013: Journal of Perinatology: Official Journal of the California Perinatal Association
Cindy W Su
Postpartum hemorrhage (PPH) is a very common obstetric emergency with high morbidity and mortality rates worldwide. Understanding its etiology is fundamental to effectively managing PPH in an acute setting. Active management of the third stage of labor is also a key component in its prevention. Management strategies include conservative measures (medications, uterine tamponade, and arterial embolization) as well as surgical interventions (arterial ligations, compression sutures, and hysterectomy). Creating a standardized PPH protocol and running simulation-based drills with a multidisciplinary team may also help decrease maternal morbidity and improve perinatal outcomes, although further studies are needed...
March 2012: Primary Care
D Ayres-de-Campos, S Deering, D Siassakos
There is little scientific evidence to support the majority of simulation-based maternity training programmes, but some characteristics appear to be associated with sustainability. Among these are a clear institutional-level commitment to the course, strong leadership in course organisation, a curriculum relevant to clinical practice, a nonthreatening learning environment, the establishment of multiprofessional training and the use of simulators appropriate to the learning objectives. There is still some debate on whether simulation-based sessions should be carried out in dedicated training time outside normal working hours or in ad-hoc drills that are run during clinical sessions, whether they should be located in clinical areas, simulation centres, or both, and whether or not they should include standardised generic teamwork training sessions...
November 2011: BJOG: An International Journal of Obstetrics and Gynaecology
Stephen D Pratt
Simulation can be used to teach technical skills, to evaluate clinician performance, to help assess the safety of the environment of care, and to improve teamwork. Each of these has been successfully demonstrated in obstetric anesthesia simulation. Task simulators for epidural placement, failed intubation, and blood loss estimation seem to improve performance. Resident performance in an emergency cesarean delivery can be measured and assessed against his/her peers. Running simulated crises on a labor and delivery unit (in situ drills) can help to identify and correct potential safety concerns (latent errors) without exposing patients to the risks associated with these concerns...
January 2012: Anesthesia and Analgesia
J Raven, B Utz, D Roberts, N van den Broek
A training package designed to train health care providers in the management of common obstetric and newborn complications using a competency based 'skills and drills' approach is used in Bangladesh and India as one of the interventions under the 'Making it Happen' programme. The programme was commenced in 2009 and aims to reduce maternal and newborn mortality and morbidity by improving health care providers' capacity to deliver Essential (Emergency) Obstetric and Newborn Care (EOC&NC) thus increasing the availability and quality of these services...
September 2011: BJOG: An International Journal of Obstetrics and Gynaecology
(no author information available yet)
Patient care emergencies may periodically occur at any time in any setting, particularly the inpatient setting. To respond to these emergencies, it is important that obstetrician-gynecologists prepare themselves by assessing potential emergencies that might occur, creating plans that include establishing early warning systems, designating specialized first responders, conducting emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. Having such systems in place may reduce or prevent the severity of medical emergencies...
April 2011: Obstetrics and Gynecology
William A Grobman, Abby Hornbogen, Carol Burke, Robert Costello
OBJECTIVE: To develop and evaluate a team-centered shoulder dystocia protocol. METHODS: This project was undertaken in two phases. The first phase consisted of protocol development, during which a basic protocol was initially developed on the basis of targeted interviews with obstetric care providers and then refined through iterative performances of the protocol. The second phase consisted of dissemination of the final protocol to obstetric providers using low-fidelity simulation...
August 2010: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
D Siassakos, K Bristowe, T J Draycott, J Angouri, H Hambly, C Winter, J F Crofts, L P Hunt, R Fox
OBJECTIVE: To identify specific aspects of teamworking associated with greater clinical efficiency in simulated obstetric emergencies. DESIGN: Cross-sectional secondary analysis of video recordings from the Simulation & Fire-drill Evaluation (SaFE) randomised controlled trial. SETTING: Six secondary and tertiary maternity units. SAMPLE: A total of 114 randomly selected healthcare professionals, in 19 teams of six members...
April 2011: BJOG: An International Journal of Obstetrics and Gynaecology
Tina Nguyen, Nathan S Fox, Frederick Friedman, Raymond Sandler, Andrei Rebarber
OBJECTIVE: To estimate the effects of computerized charting and shoulder dystocia (SD) simulation drills on the documentation of SD. METHODS: 180 cases of SD were evaluated in three consecutive time periods: T1: 45 written delivery notes; T2: 48 delivery notes after the implementation of a standardized SD note in the computerized medical record; T3: 87 computerized delivery notes after SD simulation drills. RESULTS: A standardized SD computerized note resulted in a significant improvement in documentation of EFW, diabetic status, time of the body delivery, fetal head position, which shoulder was impacted, anesthesia, the length of each stage of labor, NICU admission, the birth weight, and that a discussion took place with the patient...
November 2011: Journal of Maternal-fetal & Neonatal Medicine
Jeanne-Marie Guise, Sally Y Segel, Kristine Larison, Sarah M Jump, Marion Constable, Hong Li, Patricia Osterweil, Dieter Zimmer
BACKGROUND: Patient safety is a national and international priority. The purpose of this study was to understand clinicians' perceptions of teamwork during obstetric emergencies in clinical practice, to examine factors associated with confidence in responding to obstetric emergencies and to evaluate perceptions about the value of team training to improve preparedness. METHODS: An anonymous survey was administered to all clinical staff members who respond to obstetric emergencies in seven Oregon hospitals from June 2006 to August 2006...
December 2010: Quality & Safety in Health Care
D Siassakos, T J Draycott, J F Crofts, L P Hunt, C Winter, R Fox
OBJECTIVE: To assess whether team performance in simulated eclampsia is related to the knowledge, skills and attitudes of individual team members. DESIGN: Cross-sectional analysis of data from the Simulation and Fire Drill Evaluation randomised controlled trial. SETTING: Six secondary and tertiary maternity units in south-west England. PARTICIPANTS: One hundred and fourteen maternity professionals in 19 teams of six members; one senior and one junior obstetrician; two senior and two junior midwives...
September 2010: BJOG: An International Journal of Obstetrics and Gynaecology
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