# Presentation: 680878

## OB Emergency Drills	

- Presented by:
- Tami McBride, CNM, MS
- Karen Carey, CNM, MS

## OBJECTIVES

- Participants will be able to describe the roles, responsibilities, and “how-to’s” involved in successfully implementing OB emergency drills.
- Discuss the impact of drills on clinical practice and professional roles.
- Plan an emergency drill program for your practice setting.

## PHOENIX INDIAN MEDICAL CENTER

- Built in 1970
- 149 beds – 10 bed OB unit, of which 2 are LDRs
- 2005 stats = 840 deliveries, about 22% C/S rate

## HISTORY

- What prompted the drills?
**OB Task Force formed in 2004 to address OB Department issues**
**In reviewing certain issues, problem areas were discussed:**
**Emergency Cesarean Section that lacked good communication and teamwork**
**Shoulder Dystocia with nursing staff unsure of techniques**

## HISTORY (cont.)

- OB Task Force created an OB Emergency Drill committee to perform emergency drills that would involve all disciplines (i.e. anesthesia, lab, blood bank, pediatrics, etc.)
**Emergency drills based off Dr. Michele Lauria’s “Emergency Delivery Simulations: How to Develop Effective Teamwork” workshop in August 2004, attended by Karen Carey, CNM.**

## HISTORY (cont.)

**Emergency drills also based on recommendation in JCAHO Sentinel Event ALERT Issue # 30  “Preventing infant death and injury during delivery.” (July 21, 2004)**
**OB Emergency Drill Committee consists of:**** **
**Karen Carey, CNM (Chairperson) **
**Tami McBride, CNM (Co-chair) **
**Julia Cadwalader, RN (Nurse Educator) **
**LeAnne Prenovost, Nurse Manager, OB Unit**
**RN from day shift**
**RN from night shift**

## ADULT TEACHING/LEARNING PRINCIPLES

- Adults are usually self-motivated, self-directed, build on experience, prefer active involvement
- Provide positive environment
- Should use as many perceptual elements as possible: tactile, visual, auditory, kinesthetic
- Focus should be interpersonal & learning, meaningful & applicable

## TYPES OF EMERGENCY DRILLS

_**Emergency Cesarean Section**_** (with neonatal resuscitation drill included)**
_**Preterm Labor/Delivery**_** (with neonatal resuscitation drill included)**
_**Postpartum Hemorrhage**_** (some scenarios include an emergency hysterectomy)**
_**Shoulder Dystocia**_** (with neonatal resuscitation drill included)**

## MATERIALS NEEDED

- Team of knowledgeable staff
- Copies of your facilities’ policies and procedures
- Debriefing / evaluation form
- Real live “patient”
- Labor or Triage room
- Liter bag of IV fluid, with tubing
- O2 face mask
- Infant manikin with blankets
- Availability of infant warmer with O2, suction, etc.

## HOW DRILLS ARE CONDUCTED

- Some drills have an _educational piece_ before the drill, i.e. shoulder dystocia
- _Brief the “patient_” on scenario
- Need _3 observers_: 2 at actual scene, 1 monitoring the front desk/nursery area
- Participants have to _actually “do” things_, not just say they are doing them (except start IVs, foleys, etc.)

## HOW DRILLS ARE CONDUCTED

- _Ancillary staff involvement_ (lab, blood bank, RT, peds, anesthesia, house supervisor, etc.)
- Decision to _end drill_
- _Debriefing_ period
- _Inservices_ following, prn (trendelenberg position on bed, stirrup placement on OR table, etc.)
- _Writing up of drill_ and distributing write-up to all staff (for educational purposes)

## LESSONS LEARNED

- Initially used a manikin, switched to real person – more effective & believable, also got patient’s perspective of situation
- Communication issues
- Role confusion (charge RN, triage RN)
- How to get ancillary staff to participate
- Knowledge deficit in operating equipment (stirrups, bed)

## LESSONS LEARNED

- Systems Problems:
- Locked stairwell
- Elevators
- Blood Bank
- Paging errors (how to page STAT)
- Alarm sounds (Triage area vs. OB unit)
- Location of emergency call lever in the OR
- Location of supplies (foot stool, UVC kit, etc.)

## BENEFITS

- Improved communication & teamwork
- Role definitions
- Inservices from anesthesia (following the drill) on administration of cricoid pressure & assistance with arterial line placement
- Discovered need for shoe covers, masks, & hats to be stocked at the rear OR entrance – now supplies there

## BENEFITS

- Significant improvement in laboratory & blood bank services in receiving assistance and blood products needed in an emergency
- Improved STAT paging process
- Improved accessibility of supplies & knowledge of where supplies are located
- Hands-on working with equipment

## SBAR – Communication Tool

**S = Situation**
**What is going on with pt?  Concise statement of problem**
**B = Background**
**Background info pertinent to situation**
**A = Assessment**
**What do you think the problem is?**
**R = Recommendation**
**What action/recommendation is needed to correct problem?**

## DRAWBACKS

- Staff hate to see you coming
- Staff get suspicious when you come around