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Using fake mommies to change real
patient care
Stacy Seay Capel MSN, RN, CHSE
Lindsey Horne MHA, BSN, RN-MNN
Eileen Frager BSN, RNC-OB
Allison Talbert BSN, RNC-OB
Teresa Shelton BSN, RNC-MNN
Culver Nursing Education Lab
Novant Health Presbyterian Medical Center
Charlotte, NC
February 16, 2016
Making healthcare remarkable
Objectives:
• Describe the creation and implementation of
a regional obstetric simulation program.
• Share examples of evaluations, educational
supplements and post simulation
follow- up.
• Discuss practice improvements and
educational initiatives based on program
results
Our history.
Serving since 1903.
Making healthcare remarkable
Novant
Health
Presbyterian
Medical
Center
School
of
Nursing
Margaret
Jean
Norwood
Culver
Background:
Novant Health (NH) is a regional healthcare
provider with:
• 25,000 team members
• 13 hospitals
• 100 outpatient facilities
• 350 physician practices
NH Greater Charlotte Market is located in
southern North Carolina and includes three
Magnet designated hospitals totaling > 8,300
births/ year:
• NH Presbyterian Medical Center:
620 beds
• NH Matthews Medical Center:
146 beds
• NH Huntersville Medical Center:
91 beds
NH Greater Charlotte Market has an established
simulation program, including:
• Mobile simulation unit
• High fidelity maternal / fetal simulator
• Multidisciplinary , in situ simulation
experience
Our plan.
Building on evidence and resources.
Making healthcare remarkable
Regional OB Simulation
Objectives:
• Create and implement a regional obstetric
simulation education plan
• Provide opportunities for women’s services
staff to experience high intensity, low
frequency simulated clinical emergencies in a
safe environment
• Utilize the planned experiences to promote
engagement, team building and process
improvement
Assesment:
In January of 2015 a needs assessment was
completed utilizing:
• risk management statistics
• review of the California Maternal Quality
Care Collaborative
• staff survey results
• physician input
Action:
Three OB emergencies were identified as events
that had high staff interest, could safely be
replicated through simulation, would impact
team practice and patient outcomes:
• prolapsed cord
• postpartum hemorrhage
• intrapartum maternal code
Education plans, scenarios and audit tools were
designed.
Nursing, MD’s, anesthesia, NNP’s, ICN, surgical
techs , public safety, chaplaincy services, house
supervision, respiratory care, rapid response
teams, administration, laboratory services and
pharmacy participated in the events.
Objectives for
Intrapartum Maternal Code:
• Recognize symptoms of cardiac arrest
• Demonstrate timely execution of OBLS
emergency skills in a safe environment
• Practice effective communication between
all team members
• Participate in timing and evaluation of
process
OBLS: Arrest in Pregnant Patient
Immediately call for HELP: Emergency code cord/button
Start Compressions
 Call OB team ___________
 Get code cart ___________
 Primary RN Communicate SBARQ
With OB ________________
 Call Anesthesia _________
 Bed to CPR position _______________
 SBARQ Rapid Response/NICs __________
 Call Rapid response/NICs ___________
 Scrub tech w c/s tray w disposable scalpel
____________
 SBARQ Anesthesia _____________
 Call NICU _____________
 Assign timer/documenter _____________
 SBARQ NICU _______________
C Circulation





A Airway
 Lift chin ______________
 Open airway _____________
B Breathing
 If not intubated 30 compressions:2 breaths _______________
 If intubated breath q 6secs _______________
D Defibrillate & Deliver Fetus






100 compressions/minute ________________
Push hard, push fast _______________
Left uterine displacement _____________
Backboard/ bed in CPR mode _______________
Change compressors q 1-2min _______________
Apply AED pads front and back _______________
Analyze/defibrillate via AED _______________
Immediately Resume CPR x2min ______________
Prep for c/s or operative delivery in room ________________
Reanalyze q2min with AED ________________
Plan DELIVERY within 4-5min ___________________
Lucie Purple
37YO
253 lbs
5’8
S:The patient is a 37-year-old female just admitted to L&D at 38
weeks, 12 hours with ruptured membranes and contractions
every 3 to 5 minutes.
B: Type I diabetes, has been on bed rest since 32 weeks due to
labile blood sugars and preterm contractions. Primagravida
Allergies: No known drug allergies
Medications: insulin pump
Code Status: Full code
Social/Family History: Lives with husband, school teacher
A: You are entering the room to assess & complete the admission
Our journey.
More than simulation.
Making healthcare remarkable
3 scenarios
3 facilities
5 educators
10 months
14 departments
19 simulated clinical events
207 multidisciplinary participants
Our story continues.
Taking care of our community.
Making healthcare remarkable
Changes Implemented:
• Emergency c/s delivery pack reconfigured
• Rapid Response Team granted badge access to
women’s services
• Bimanual uterine massage educational
initiative
• Introduction of quantitative blood loss
communication and measurement
standards
• Recognition of need for competencies related
to sterile vaginal exams performed outside
labor & delivery
• Postpartum hemorrhage tool boxes and Pyxis
medication bundles created
• Team communication related to hemorrhage
protocols and emergency role assignment
• Betadine availability in the women's services
OR
References:
Clapper, T. C. (2013). In Situ and mobile simulation: Lessons learned… authentic
and resource intensive. Clinical Simulation in Nursing, 9(11), e551-e557.
Jeffries, P.R. (2007). Simulation in nursing education. New York, NY: NLN.
Lyndon, A., Johnson, M., Bingham, D., Napolitano, P., Joseph, G., Maxfield, D. & O’Keeffe, D.
transforming Communication and safety culture in intrapartum care. Obstetrics &
Gynecology, 125(5), 1049-1055.
The INACSL Board of Directors (2015, June). Standards. Clinical Simulation in Nursing,
11(6), 309-315. doi:10.1016/j.ecns.2015.03.005
Troiani, N., Harvey, C., & Chez, B. (Eds.). (2013). High-Risk & critical care obstetrics
third edition. New York, NY: Wolters Kluwer Health Lippincott Williams & Wilkins.
.
Contact Information
Stacy Seay Capel MSN, RN, CHSE
[email protected]
704.384.5597
Making healthcare remarkable