Purpose for the Program
The special delivery unit in the Children's Hospital of Philadelphia is designed to perform fetal surgery and deliver fetuses with known anomalies. Because of the low volume, staff are challenged with maintaining obstetric emergency competencies and learning to run adult emergencies within a children's hospital. The purpose was to provide the interdisciplinary staff with realistic obstetric emergency situations to identify educational opportunities using simulation and debriefing and to identify barriers to providing appropriate care. This learning modality was selected so that staff could practice in a team environment that best portrays an obstetric emergency.
To use multidisciplinary simulation for team education rather than the annual obstetric-competencies education day provided in a lecture format for nurses. With this change, physicians, midwives, and nurses will work together as a team and focus on team dynamics as well as clinical objectives.
Implementation, Outcomes, and Evaluation
The simulation program was implemented by creating a multidisciplinary planning team, in coordination with the hospital simulation team, to prioritize the highest risk, low-volume obstetric emergencies. To select these topics, the group took into consideration information from risk management, Joint Commission recommendations, and problem-prone areas. Scenarios were created combining that information with the simulation model capabilities. Time was scheduled to ensure that all members of the obstetric team were able to attend one simulation. Each simulation lasted 4 hours and included the simulation of a maternal code, shoulder dystocia, postpartum hemorrhage, and fire in the operating room. After completing the simulations, staff feedback and evaluations were reviewed. The need for more frequent simulations and the need for easier access to supplies during a postpartum hemorrhage were identified. As a result, simulations are now being planned for twice a year and a postpartum hemorrhage cart was created.
Implications for Nursing Practice
There are many positive implications for using simulation as a learning modality. It provides education on clinical skills and promotes team communication skills that are vitally important in an emergency. Additional implications are the ability to identify process issues and make changes that could quickly affect practice. Simulation also offers the opportunity to practice skills in a nonthreatening atmosphere where questioning practice is an expectation and making mistakes has no adverse effects on the patient.