Purpose for the Program
Ineffective teamwork and communication failures contribute to 70% of adverse obstetric events. Citing an increase in maternal mortality, the American College of Obstetricians and Gynecologists (ACOG) and the Joint Commission recommended creating obstetric rapid response teams. These recommendations include using drills to ensure competency during emergencies.
Our institution developed a rapid response team (RRT) of nurses, residents, attending physicians, and ancillary staff from the obstetrics, neonatology, and anesthesiology departments.
We used the Plan-Do-Study-Act (PDSA) methodology to train RRT members to identify system and process barriers that impede effective emergency response. Changes, based on these observations, were trialed during live videotaped in situ simulations. If, after debriefing, the group deemed the changes worthwhile, an action plan to implement the change was created. Changes were incorporated into obstetric emergency protocols and reviewed at the next training session.
The purpose of this innovative program was to train the obstetric RRT in PDSA cycle use (through multidisciplinary simulation) to achieve the following three goals: (a) identify the most common errors during obstetric emergencies and reduce them by 50% in 1 year; (b) increase the number of rapid response calls by 50% in 1 year; and (c) decrease the time from the rapid response call to team response by 25% in 1 year.
Implementation, Outcomes, and Evaluation
Each multidisciplinary training session includes the following: RRT lectured in one obstetric emergency per session; videotaped live simulation in the unit, which is witnessed by the entire RRT; RRT divides into small groups and use PDSA method to discuss needed changes/process improvements; the entire RRT debriefs on simulation/small group simulation results; the debrief action plan is created based on group PDSA/simulation findings; PDSA changes are trailed clinically by teams during real calls; and successful changes are implemented and reviewed at the next training session.
Since implementation of the RRT, we have increased accessibility of equipment and supplies by 50% by creating RRT carts, increased accessibility to uterotonic medications by 50%, increased team response calls by 50%, successfully implemented two mass alert communication systems, and created and completed three group simulation.
Implications for Nursing Practice
Multidisciplinary PDSA cycle training creates objective team building and problem solving. This gives healthcare providers ownership in change that directly affects clinical care. PDSA simulation training aids in improving staff emergency preparedness, identifying the most common obstetric emergency errors, and creating evidence-based protocols based on successful PDSA change implementation.