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Peripartum Arrest- Is our team ready?
Abstract Number: F-56
Abstract Type: Original Research
Obstetrical “code” situations are relatively infrequent, but preparedness of the entire labor and delivery staff to act quickly in such an event is imperative for optimal outcome. Delay in defibrillation is associated with worse survival in patients with ventricular fibrillation or pulseless ventricular tachycardia as may occur after massive pulmonary embolism or amniotic fluid embolism. Other institutions have recently found improvement in outcomes and have identified operational deficiencies through the use of simulation sessions.
On four different dates, we conducted in situ simulation sessions during which a team of nurses encountered a patient who experienced post-delivery loss of consciousness and ventricular fibrillation. We noted whether or not the participants called for help, placed monitors, and noted the abnormal rhythm. We then recorded the amount of time required to attain the code cart, attach defibrillator pads, and deliver a shock. Participants filled out pre and post simulation surveys and participated in a brief teaching session that focused on use of the defibrillator. Posters were placed around labor and delivery to reinforce key points after the initial teaching sessions. We attempted to have all participants attend the simulation on two different days approximately one month apart. We compared data from the first and second sessions to assess whether or not there was improvement in performance after our efforts at simulation and education.
Results: See attached table
This study demonstrates a statistically significant improvement in performance in a code situation after simulation and education, including reduction in time to attain the code cart and defibrillate. While in situ simulation offers the benefit of realistic and applicable training, it poses challenges on labor and delivery where practitioner availability is unpredictable. The number of providers involved in our study was limited by high clinical volume on two of our simulation dates. The nurses who participated felt that these simulation sessions boosted clinical skills and self-confidence. Simulating other peripartum emergencies and creating a culture of multidisciplinary simulation (ie. involving obstetric and neonatal staff) is a future goal for our institution.
Ventre et al.Simul Healthc 2014;9:102-11.
Monod et al.Arch Gynecol Obstet doi:10.1007/s00404-013-3111-2014.289
Egenberg etal.Acta Obstet Gynecol Scand 2014.