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Tuesday, November 18, 2014
Noon Eastern
Slide 1
Tamika Auguste, MD, FACOG
Director, OB/GYN Simulation
MedStar Health
Associate Professor, Obstetrics & Gynecology
Georgetown University School of Medicine
Mary Calabrese, MSN, RN
Director, MedStar Health Clinical Simulation Services
Simulation Training & Education Lab (SiTEL)
Slide 2
Disclosures
 Tamika Auguste, MD, FACOG has no real or
perceived conflicts of interest to disclose.
 Mary Calabrese, MSN, RN has no real or
perceived conflicts of interest to disclose.
Slide 3
Objectives
• The participant will identify the importance of conducting
interdisciplinary simulation drills in obstetrical hemorrhage
• The participant will understand how to conduct simulation
drills in obstetrical hemorrhage
• The participant will be able to provide methods for a
successful debriefing
• The participant will identify key takeaways for tailoring drills
based on the resources available at their organization
Slide 4
Postpartum Hemorrhage
• 2-5% of all births in U.S. are affected by
obstetric hemorrhage
• Top cause of maternal death in U.S. and
worldwide
Slide 5
Etiologies
• 80% of cases due to
uterine atony
• Retained placenta or
placental
complications
• Uterine trauma
• Defects in coagulation
Slide 6
Managing this Emergency
• Didactics and Invited
Lecture - Ongoing education
• Collaboratives &
Initiatives - CMQCC and Safe
Motherhood Initiative
• In-Services - Walk through,
asking questions
• Simulation - Team based
drills
Slide 7
What Does It Take?
• Leadership Support
– Awareness
– Organizational Goals
– Resources
• Time
• Money
Slide 8
Simulation Education
• Simulation based interdisciplinary team
training drills
– Communication/Teamwork
– Understanding the bundle
– Assessing policy
Slide 9
Simulation Education
• Setting up the drills - 4 Core Focuses
– Communication/Teamwork
• Communication Breakdowns - primary cause of > 70%
of events analyzed
• 55% - Organizational culture a barrier to
communication and teamwork
– Situational awareness
• A shared and accurate understanding of “what’s going
on” and “what is likely to happen next”
Allows us to recognize events around us, act correctly
when things proceed as planned, and react
appropriately when they don’t
Slide 10
Simulation Education
– Pre-briefing
• Briefing gets us on the same page so we can watch
out and help each other
• Promote teamwork and collaboration
– Debriefing
• What did we do well? What did we learn? What
would we do differently next time ?
• Free and open learning discussion
Slide 11
Bringing Simulation to Life
•
•
•
•
•
Identify champions
Create objectives
Measure success
Simulation day
Debriefing
Slide 12
Identify Champions
• Identify Experts
– Scenario writing – subject matter experts
– Assess learners during the evaluation
– Communicate with leadership and front line
– Determine logistics
– Debrief the event
Slide 13
Create Objectives
• Why are we doing this?
– Run the bundle and look at policy
– Create policy
– Teamwork and communication training
Slide 14
Measure Success
• Develop your evaluation
– Participants critical actions
– Following the bundle and policy
– Participant Completion
Slide 15
Simulation Day
• Create a safe learning environment
– Make it real
– Encourage them to “pretend”
– Allow for mistakes to occur
Slide 16
Debriefing Goals
• Bring it back to clinical practice
• Reflective learning
• Create awareness
Slide 17
Debriefing
• Advocacy – inquiring debriefing
– I noticed you discovered the low blood
pressure quickly, then you walked out of the
room – tell me what you were thinking when
you left the room.
– Empathy – “see what they see” through their
lens
Slide 18
Debriefing
• Reflective learning
– Offer the team to discuss the why’s
– Questioning
• What is another way this could have been handled?
• How will you manage this in the clinical setting?
• Compare this to a clinical situation they have had
Slide 19
Next Steps
•
•
•
•
Follow up
Report findings
Debrief the event
Make changes
Schedule your next simulation
Slide 20
Key Takeaways for Success
• Obtain leadership buy-in
• Understand your policies and procedures
• Obtain champions who can help make this
successful
• Stick to your objectives (keep it simple)
• Create a safe learning environment
• Remember YOU and YOUR learners will
both be learning
Slide 21
References
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•
•
•
•
•
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Andreatta PB, Bullough AS, Marzano D. Simulation and Team Training. (2010)
Clinical Obstetrics and Gynecology, 53(3): 532-44.
Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United
States 1994-2006. (2010) Am J Obstet Gynecol, 202(4):353.
Combs CA, Murphy EL, Laros RK Jr. Factors associated with postpartum hemorrhage
with vaginal birth. (1991) Obstet Gynecol, 77:69-76.
Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. (2007)
Simul Healthc, 2:115-25.
Salas E, Almeida SA, Salisbury M et al. What are the critical success factors for team
training in health care? (2009) Jt Comm J Qual Patient Safety, 35(2):398-405.
Rudolph JW, Simor R, Rivard P, Dufresne RL, Raemer DB. Debriefing with good
judgement: combining rigorous feedback with genuine inquiry (2007) Anesthesia
Clin., 25:361-76.
Postpartum hemorrhage. ACOG Practice Bulletin No. 76. American College of
Obstetricians and Gynecologists. (2006) Obstet Gynecol, 108:1039-47.
Slide 22
Q&A Session
Press *1 to ask a question
You will enter the question queue
Your line will be unmuted by the operator for your turn
A recording of this presentation will be made available on our website:
www.safehealthcareforeverywoman.org
Slide 23
Next Safety Action Series
Obstetric Hemorrhage: A Year in Review
Wednesday, December 10 | Noon ET
Maternal-Fetal Medicine
Midwifery/Nursing
Anesthesia
Richard Berkowitz, MD, FACOG
Columbia University
Lisa Kane Low, PhD, CNM, FACNM
University of Michigan
Barbara Scavone, MD
The University of Chicago
Click Here to Register
Slide 24
Introducing:
The National Improvement Challenge
•
•
•
To encourage patient safety and quality improvement projects related to obstetric
hemorrhage and severe maternal morbidity.
To increase widespread implementation of the Obstetric Hemorrhage Patient Safety
Bundle or Severe Maternal Morbidity Reporting Forms.
To foster a culture of collaboration, teamwork, patient safety, and communication between
clinicians and patients.
Open to any individual or team in the United States
currently in any of the following:
Educational Programs
• Clinical Nurse Specialist (CNS)
• Doctor of Nursing Practice (DNP)
•
Nurse Anesthetist (CRNA, DNAP)
• Nurse Practitioner (NP),
• Midwifery (CM, CNM)
Residency Programs
• Anesthesia
• Family Medicine
• Obstetrics and Gynecology
• Osteopathic Obstetrics and Gynecology
First Place Award
• $3,000 cash award (check to be made payable to program)
• 2 paid registrations to ACOG’s annual meeting or other
national meeting of a selected clinical professional
organization
• Opportunity to present project on a national stakeholder
teleconference
Awards are also given for 2nd, 3rd, and 4th place submissions.
Declaration of intent due January 15, 2015
Final submission due June 15, 2015
Additional information on how to apply will be made available our website:
www.safehealthcareforeverywoman.org
Slide 25