Simulations in the Management of Obsetric Emergencies

Book excerpt: Background: In 1997, the Institute of Medicine reported that between 48,000 to 98,000 people die in the US hospital due to preventable medical errors. Additionally, The Joint Commission reported that 65% of medical errors are due to failure in communication. Medical errors have impacted society because patients were harmed, with greater impact on the patient's families. Similarly, medical errors have impacted health care providers due to litigations, loss of status, loss of income, and potential loss of licensure. Simulations emerged as responses to rectify individual, organizational, and systems failures that resulted in patient harm. From ethical standpoint, the use of simulations conveys critical educational message: patients are to be protected whenever possible. They are not commodities to be used as conveniences of training. Simulations focus on improved communications, improved clinician's knowledge and skills in a controlled, risk-free environment. Simulation is an effective tool in promoting a culture that encourages identification of risks to medical errors in a non-punitive, risk-free environment. Foreground: High risk obstetric patients present challenges to the healthcare providers. Obstetric-related claims often represent high severity in terms of both injury and payouts. The average insurance payout ranges from $1.2 to $10 million. Researchers have shown that onsite simulations demonstrated a positive impact on obstetrical patient safety. These obestetric drills resulted in improved quality of care. EBP Framework: Knowledge dissemination was promoted through the use of a communication model, Organizational Information Theory developed by Karl Weick. Johns Hopkins Nursing Evidence-Based Model was used because of its similarity to nursing process in the utilization of a systematic approach. In addition, the model encourages the use of critical thinking in the acquisition of evidence-based knowledge. Methods: The purpose of this capstone project was to demonstrate that simulations in a labor and delivery unit in a community hospital can improve perinatal patient safety in a cost-effective manner through improved teamwork, improved communication and improved skills and knowledge. Simulations in the management of obstetric emergencies were performed through the use of roleplaying. The Safety Attitude Questionnaire (SAQ) tool was used to measure the team's perception of safety climate of the unit. Findings: The overall results of the SAQ survey demonstrated an improvement in the participants' perceptions of teamwork, safety, communication, job satisfaction, workplace condition, and perception of management. While the project was limited due to the low number of staff and physicians who participated in the project and no participation from the respiratory therapists, the overall results of the SAQ survey demonstrated some improvement in many areas. Conclusion: There are areas of concern; identification of these issues is critical in taking necessary steps to identify measures to improve them. Additionally, the SAQ results demonstrate a need for continued application of simulation and measurement of tthe obsetric multidisciplinary team's perception of communication, teamwork, safety, job satisfaction, and workplace condition.