Let's TWIST (Teambuilding in Women's Health Incorporating Simulation Training): Implementing Obstetric Crisis Simulation Program
Article first published online: 14 JUN 2012
© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2012 Convention Proceedings
Volume 41, Issue s1, page S112, June 2012
How to Cite
Ellison, K., Bierman, M. L. and Knitowski, I. (2012), Let's TWIST (Teambuilding in Women's Health Incorporating Simulation Training): Implementing Obstetric Crisis Simulation Program. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41: S112. doi: 10.1111/j.1552-6909.2012.01361_88.x
- Issue published online: 14 JUN 2012
- Article first published online: 14 JUN 2012
- simulation training;
Purpose for the Program
In 2009, Baltimore Washington Medical Center opened the Pascal Women's Center offering maternal–child services. As the unit was in its developmental phase, the management team and the unit's quality team decided it would be beneficial to implement simulation training in the new obstetric unit to ensure that staff developed and maintained crisis skills.
The group recognized required changes in patient outcomes and staff training.
Implementation, Outcomes, and Evaluation
In December of 2010, Pascal Women's Center instituted their version of simulation training called TWIST, Teambuilding in Women's Health Incorporating Simulation Training, which includes managing patients with shoulder dystocia, postpartum hemorrhage, prolapsed cord, and neonatal resuscitation. During this training, clinical skills, crisis management processes, and TeamSTEPPS tools were incorporated. Each scenario was videotaped followed by a debriefing period. The staff and facilitators identified areas of strength and developed a commitment to improve our processes of managing obstetric crises. The initial phase of simulation training inspired new ideas for continuing the TWIST program. The leadership team felt crisis training makes a significant improvement in outcomes and staff readiness. According to the Hospital Consumer Assessment of Healthcare Providers and Systems surveys, perception of safety before institution of TWIST training was 79% and after institution safety perceptions increased to 89%. Therefore, every month TWIST facilitators conduct an unannounced simulation training in which the staff engages in realistic scenarios to improve safety, processes, and maternal–neonatal outcomes.
One TWIST scenario examined a newborn resuscitation in the mother–infant unit. Our goal was not only to review clinical skills of the neonatal resuscitation program, but also to examine the processes and resources for staff within the organization. During this TWIST training, the team was able to identify telecommunications failure to reach all essential obstetric and pediatric staff. Another issue identified was a breakdown in the emergency call buttons, requiring follow-up by facilities. TWIST training enlightened the staff to clinical and operational breakdown. As a result, this scenario prepared staff clinically for preventing operational breakdowns that may have occurred in an actual emergency.
Implications for Nursing Practice
Pascal Women's Center is now involving different departments into our monthly training, which includes the emergency department, blood bank, emergency medical services, and laboratory. Through the incorporation of these units, the goal is to optimize patient care and emergency responses. TWIST is recommended to other units and organizations in order to focus on patient safety and improve outcomes.