Safe Obstetric Care in a Rural Setting: Preparing for Low Frequency/High Risk Events


Paper Presentation

Purpose for the Program

Every obstetric department works to provide safe outcomes for mothers and infants. Many rural critical access hospitals provide low-volume, low-risk obstetric care. However, they must be prepared to deal with any catastrophic event associated with increased maternal or neonatal morbidity or mortality. And yet, they are challenged to find the best way to implement evidence-based care when these events happen so infrequently. Large urban facilities have resources that may include clinical nurse specialists, nurse educators, nurse practitioners, and access to large ancillary services. But how does a facility hundreds of miles from a large tertiary facility develop competency in their staff members?

Proposed Change

Improving patient outcomes requires use of evidence-based care, applying systems thinking, and increased training. This rural facility put together evidence-based protocols to facilitate emergent care for placenta abruption, extreme prematurity, and hemorrhage, all low-frequency occurrences that have been experienced with poor outcomes. The proposed changes included modifying the roll-specific functions and responses, initiating the chain of communication, and redesigning unit and regular drills.

Implementation, Outcomes, and Evaluation

The first step included a root cause analysis of low-frequency, high-risk events. From this, a protocol was developed, adapting to the unique resources and needs of this small facility. The next step was to test the protocol. Simulation with a simulation mannequin was used and every clinical staff member who provided obstetric care participated, including physicians. Revisions were made to the protocol and retested. In addition, clinical decision support was added to the electronic medical record to prompt the clinician to the appropriate actions and orders in a given situation. The electronic medical record also prompts for appropriate documentation to ensure a complete record.

Implications for Nursing Practice

Overall, staff readiness was improved by using simulation to define the process, educate, and assess competency. The use of simulation for ongoing team evaluation will continue to reinforce these skills so if the unthinkable happens, this nursing and medical staff will be prepared to ensure the most optimal outcome.