Standardisation of multidisciplinary obstetric emergency training - - PowerPoint PPT Presentation

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Standardisation of multidisciplinary obstetric emergency training - - PowerPoint PPT Presentation

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1 IMOET National Meeting Tuesday 30th September 2014 Dublin Castle Standardisation of multidisciplinary obstetric emergency training nationally. Teamwork and Obstetric Emergencies Dr Niamh Hayes ATM Return: Aim: Get cash! Simple task

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IMOET National Meeting Tuesday 30th September 2014 Dublin Castle

Standardisation of multidisciplinary obstetric emergency training nationally.

1

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Teamwork and Obstetric Emergencies

Dr Niamh Hayes

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  • Aim: Get cash!

ATM Return:

Simple task…

  • Cash return first?
  • Card return first?
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  • Aim: Get cash!

ATM Return: Cash return first:

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  • Aim: Get cash!

ATM Return: Cash return first:

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  • Aim: Get cash!

ATM Return: Card return first:

> 10,000 transactions p.a. leave cash behind > €1,000,000 p.a. … single bank R.O.I.

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  • Aim: Get cash!

ATM Return: Card return first:

Simple cognitive error…

  • Person capable of performing task safely
  • Has done so many times in the past
  • Faces significant personal consequences for error
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Complexity of medical crisis?

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▫ Context ▫ Definition ▫ Principles ▫ Metrics ▫ Resources ▫ Summary

Outline

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44,000 - 98,000 deaths p.a.

Context: Scope of the problem

IOM “To Err is Human” 1999

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600 - 1300 deaths p.a.

Context: Scope of the problem

IOM “To Err is Human” RoI?

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442 deaths 1999

Context: Scope of the problem

Commercial aviation fatalities worldwide 1999

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Causes?

technical competencies procedural knowledge psychomotor skills non-technical competencies cognitive skills social skills safe task completion

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  • Non-technical failures

resource management

Causes?

cockpit

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  • Non-technical failures

resource management

Causes?

crew

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  • Non-technical failures

resource management

Causes?

crisis

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  • Crisis resource management:

“The ability to translate medical knowledge to real world actions in the setting of an emergency”

Definition

Howard SK et al. Anesthesia crisis resource management training : teaching anaesthesiologists to handle critical incidents. Aviation, space and environmental medicine 1992

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Principles of CRM

EFFECTIVE COMMUNICATION MUTUAL RESPECT SHARED DECISION MAKING SITUATIONAL AWARENESS USE ALL AVAILABLE RESOURCES LEADERSHIP AND FOLLOWERSHIP

Adapted from: Rall and Gaba, Miller’s Anesthesia 7th Edition

* * * * *

*Teamwork elements from ACLS provider manual 2010, PROMPT provider manual

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Principles of CRM

EFFECTIVE COMMUNICATION CLOSED-LOOP COMMUNICATION Strategy of verification to make sure that the message sent was received and interpreted as intended

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Principles of CRM

EFFECTIVE COMMUNICATION STRUCTURED COMMUNICATION

From HSE.ie and App Store (accessed 15th September 2014)

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National guideline for communication (handover) in maternity services in Ireland

Principles of CRM

295 pages!!!

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Principles of CRM

LEADERSHIP AND FOLLOWERSHIP USE ALL AVAILABLE RESOURCES

  • Clear role/task allocation
  • Know limitations and ask for help early
  • Mutual support/cross checking
  • Objective evidence (point of care testing)
  • Human resources
  • Cognitive aids (algorithms)
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Principles of CRM

SITUATIONAL AWARENESS

What? So what? What now? Information gathering? Understanding? Anticipation?

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Principles of CRM

MUTUAL RESPECT SHARED DECISION MAKING

  • “Power distance” (hierarchy)
  • Treat input from other team members

legitimately

  • “hint and hope”…
  • SBAR?
  • Critical language: CUS
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Principles of CRM

EFFECTIVE COMMUNICATION MUTUAL RESPECT SHARED DECISION MAKING SITUATIONAL AWARENESS USE ALL AVAILABLE RESOURCES LEADERSHIP AND FOLLOWERSHIP

Adapted from: Rall and Gaba, Miller’s Anesthesia 7th Edition *Teamwork elements from ACLS provider manual 2010, PROMPT provider manual

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  • Domain/context-specific training interventions
  • Good face validity…
  • Evidence for construct validity (translational science)?

Metrics

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Metrics: Evidence for success?

Siassakos D et al. The active components of effective training in obstetric emergencies. BJOG 2009;116:1028-32

Southmead Hospital, Bristol (UK)

  • Infrastructural changes (protocols, props…)
  • Regular in-house drills for all staff
  • 51% reduction in Apgar5 <7
  • 50% reduction in HIE
  • 75% reduction in Erb’s palsy after shoulder

dystocia

  • 40% reduction in median DDI for cord prolapse

Draycott T et al. Does trianing in obstetric emergencies improve neonatal outcome? BJOG 2006;113:177-82 Draycott T et al. Improving neonatal outcome through practical shoulder dystocia training. Obstet Gynecol 2008;112:14-20 Siassakos D et al. Retrospective cohort study of DDI with umbilical cord prolapse: the effect of team training. BJOG 2009;116:1089-96

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Metrics: Evidence for success?

Siassakos D et al. The active components of effective training in obstetric emergencies. BJOG 2009;116:1028-32

BDIMC, Boston (US)

  • Teamwork course for all staff
  • Debriefings, improved handover
  • Protocol development
  • Selected clinical drills
  • 23% reduction in adverse obs events
  • 62% reduction in malpractice claims
  • Labour staff > positive attitude to safety

Pratt S. Impact of CRM-based team training on obstetric outcomes and clinicians’ safety attitudes. Jt Comm J Qual Patient Saf 2007;33:720-5

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Metrics: Evidence for success?

Siassakos D et al. The active components of effective training in obstetric emergencies. BJOG 2009;116:1028-32

Liverpool Women’s Hospital (UK)

  • Integrated risk management
  • Patient involvement
  • Regular team briefings and drills
  • Infrastructural improvements
  • 11% reduction in AE with suboptimal care
  • 50% reduction in Apgar5 <4
  • 50% reduction in cord pH <7
  • 86% reduction in Erb’s palsy

Scholefield H. Embedding quality improvement and patient safety at Liverpool Women’s NHS Foundation Trust. Best Pract Res Clin Obstet Gynecol 2007;21:593- 607

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Metrics: Evidence for success?

Siassakos D et al. The active components of effective training in obstetric emergencies. BJOG 2009;116:1028-32

Rigshospitalet, Copenhagen (DK)

  • Clinical drills
  • Streamlined protocols
  • Eclampsia and haemorrhage boxes
  • Improved staff confidence scores & 45%

reduction in midwifery staff sick leave

Sorensen JL. The implementation and evaluation of a mandatory multi-professional obstetric skills training program. Acta Obstet Gynecol Scand. 2009;88(10):1107-17

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Metrics: Evidence for success?

Evidence = association (not causation) Institution-level incentives to training and safety culture Non-threatening training and assessment for entire workforce Self-directed infrastructural changes (local solutions) Relevant, in-house training Realistic training tools (high fidelity) Multiprofessional clinical and teamwork training

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Resources?

Guideline Personnell Other Metrics O & G Ireland Obstetric Manikins Face validity satisfaction scores COMPASS training manual (HSE) Midwifery Birthing Simulator Others? NEWS guideline (appendix 6, HSE) Anaesthesia Resus Manikin Unit dependent? ISBAR app (iTunes & android) +++

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Practical skills & drills elements

EFFECTIVE COMMUNICATION MUTUAL RESPECT SHARED DECISION MAKING SITUATIONAL AWARENESS USE ALL AVAILABLE RESOURCES LEADERSHIP AND FOLLOWERSHIP

TTT elements Elements for certain scenarios

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  • If you do only one thing when you return to your unit,

use ISBAR

Looking forward