Download Simulation-Exercise-PPH-RCL-3-2-2-3

Simulation: Postpartum Hemorrhage Rapid Cycle Learning Template
Equipment needed:
Student nametags with role assignments
Static manikin, low or high fidelity simulator
Patient chart
Patient ID bracelet
Stretcher or hospital bed
Blankets
Top Sheet
Peri-pads
Under pads
Red food coloring
Sphygmomanometer
Stethoscope
Pulse oximetry
Variety of angio-catheters
Intravenous access
Intravenous fluids: 1000 ml Lactated Ringer’s, 1000 ml 0.9% NaCl, 1000 ml D5W, 1000 ml
0.45% NaCl
Intravenous tubing
Intravenous pump and pole
Medication cart with syringes
Simulated meds: oxytocin (Pitocin), methylergonovine (methergine)
Wall suction to oxygen
SBAR form
Vital sign flow sheets
Input and output forms
Blood specimen tubes
OR consent form
Audio or video recording device
Optional: Blood transfusion, y-tubing, blood product documentation forms
Play Telephone
Foley Catheter
Background information: A case is provided to the students by the faculty. Faculty can use case
included or create one of their own. If there are multiple simulation groups running in different
labs, an option to create more than one case study is recommended, so students learn from the
going through the rapid cycle process themselves, rather than their peers divulging the
experience prematurely.
Postpartum hemorrhage simulation lab exercise initially created by Carol Carofiglio, PhD, RN. as course leader. Modified by Randi Flexner DNP,
APN-C, FNP-C, RN to include Rapid Cycle Learning, PDSA-Model of Improvement, SBAR, Rubric Scoring, Case Study & AudioVideo recording.
Background information: Case Study
Tiffany Jones, 35 years old, G6 P5, was in labor for 16 hours when she delivered twins,
vaginally, a 8 lb. 8 oz. male infant at 1935 PM and a 7 lb 8 oz. female at 1938 PM. Tiffany had a
continuous epidural placed in active labor. The epidural was discontinued at 1930. She has iron
deficiency anemia but otherwise an unremarkable medical history. She has NKDA. Her
obstetrical history includes prior 1 spontaneous abortion 10 years ago, vaginal delivery of twins,
4 years ago, one singleton vaginal delivery, 2 years ago, and the vaginal delivery of twins today.
Tiffany planned on bottle feeding the newborns. She tells the nurse she is very hungry and tired.
Her history did not include any pregnancy or delivery complications and outcomes were positive.
Tiffany’s husband is at the bedside. He tells the nurse upon entering the room that his wife is
really tired, and keeps dozing off. He is worried of how pale she looks.
Students begin cycle 1: Working collectively in a group as “one” nurse to conduct initial
assessment and brainstorm nursing actions. Faculty Facilitator only reports vital signs
information upon student request on assessment.
Vital signs: B/P 90/60, 88, 20, 98.6
Level of consciousness: Lethargic but responsive
Students should address on own:
 Skin color: Pale
 Location and firmness of uterine fundus:
 Amount of lochia:
 Perineum:
 Presence and location of pain:
 Intravenous infusions: 3000 ml of Lactated Ringers with 20 units of Pitocin in each bag
at slow rate, KVO
 Urinary output:
 Level of feeling and ability to move post-epidural:
1. Rubric scoring based on what was observed by faculty and further during the
Debriefing/view audio/video
2. Reflection-students verbalize in a group with faculty facilitation how the first cycle
process was perceived, self-reflection and group dynamics.
Students begin cycle 2: TURN on audio/video recording device. Working together in assigned
nursing roles in pairs.
Example:
1) Patient care nurse 2) Unit charge nurse 3) Unit staff nurse. Faculty Facilitator only reports
vital signs information upon student request on assessment. Patient condition worsens.
Patient complains of shortness of breath, difficulty in answering nurses questions, expresses
anxiety/fear that something is wrong. Faculty Facilitator indicates uterus is soft and boggy,
and peri-pads feel very wet. Faculty Facilitator in provider role, unable to reassess patient at
this time due to another delivery but provides orders to increase Pitocin, administer oxygen,
call blood bank for type and cross and anticipatory need for transfusion.
Postpartum hemorrhage simulation lab exercise initially created by Carol Carofiglio, PhD, RN. as course leader. Modified by Randi Flexner DNP,
APN-C, FNP-C, RN to include Rapid Cycle Learning, PDSA-Model of Improvement, SBAR, Rubric Scoring, Case Study & AudioVideo recording.
Students should address on own:
 Skin color: Pale
 Location and firmness of uterine fundus:
 Amount of lochia:
 Perineum:
 Presence and location of pain:
 Need for oxygen, and increase rate of intravenous fluids based on assessment
 Need to inform physician for further evaluation
 Should demonstrate patient advocacy and insist that a healthcare provider (NP,
resident) immediately re-evaluate patient while primary provider is unable.
 Communicate to charge nurse change of patient status, anticipatory return to OR
 Student should communicate with husband and patient throughout scenario,
keeping them well informed
 Student should request assistance from staff nurse as needed, instruct to bring crash
cart/med cart nearby
1. Rubric scoring based on what was observed by faculty and further during the
Debriefing/view audio/video
2. Reflection-students verbalize in a group with faculty facilitation how the first cycle
process was perceived, self-reflection and group dynamics.
Students begin cycle 3: TURN on audio/video recording device. Student now individually
assigned nursing roles. Example: 1) Patient care nurse 2) Charge nurse 3) Unit staff nurse 4)
Operating room nurse. Faculty Facilitator only reports vital signs information upon student
request on assessment. Faculty Facilitator role plays as physician/provider who reassesses
patient at bedside. Patient nurse or Charge nurse should provide physician with an SBAR
report. Faculty facilitator provides new orders: increase fluid rate, administer
methylergonovine (methergine), insert foley catheter, instruct nurse to notify blood bank for
blood transfusion sent to OR stat, instruct nurse to notify OR nurse of need for immediate OR
room. Faculty facilitator should increase level of urgency and required actions.
Students should
 Be patient advocate for emergent reassessment of physician.
 Provide detailed SBAR report to provider and OR nurse accordingly
 Keep patient and husband well informed
 Recognize need for additional nursing assistance, communicate, and delegate
 Administer medications as ordered
 Insert foley catheter if ordered
 Demonstrate interdisciplinary collaboration, communication with Blood bank,
resident, physician, and nursing staff.
 Student should request assistance from staff nurse as needed, instruct to bring crash
cart/med cart nearby if not previously done, anticipate needs.
Postpartum hemorrhage simulation lab exercise initially created by Carol Carofiglio, PhD, RN. as course leader. Modified by Randi Flexner DNP,
APN-C, FNP-C, RN to include Rapid Cycle Learning, PDSA-Model of Improvement, SBAR, Rubric Scoring, Case Study & AudioVideo recording.
1. Rubric scoring based on what was observed by faculty and further during the
Debriefing/view audio/video
2. Reflection-students verbalize in a group with faculty facilitation how the first cycle
process was perceived, self-reflection and group dynamics.
Postpartum hemorrhage simulation lab exercise initially created by Carol Carofiglio, PhD, RN. as course leader. Modified by Randi Flexner DNP,
APN-C, FNP-C, RN to include Rapid Cycle Learning, PDSA-Model of Improvement, SBAR, Rubric Scoring, Case Study & AudioVideo recording.