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Role Assignment for Obstetric Basic Life Support: A Feasibility Study
Abstract Number: S2D-8
Abstract Type: Original Research
Introduction: In previously conducted in-situ maternal arrest simulations in our labor and delivery suite, we observed a lack of knowledge about modifications for Obstetric Basic Life Support (OBLS) and ineffective team performance, particularly unclear roles and responsibilities. The study purpose was to test the feasibility of conducting situ interprofessional OBLS simulations for a large nursing staff along with obstetric and anesthesia residency programs. We examined the impact of explicit role assignments for adherence to critical tasks as well as time to completion of critical tasks (call for help, starting CPR, left uterine tilt and incision for emergency delivery).
Methods: Twenty-four interprofessional teams comprising 4 nurses, 1 anesthesia resident and 1 obstetric resident were randomized to either a Control or Study group. Before the simulation, participants completed an online OBLS training module. Additionally, the Study Group received instructions and task cards for role assignment for nurse responders: 1st responder (call for help, start CPR, document time, left uterine tilt – when 2nd responder comes in), 2nd responder (CPR), 3rd responder (crash cart, defibrillator, drugs, document) and 4th responder (bag-mask ventilation). The simulation was conducted in situ in a labor and delivery room. Teams used the same processes, equipment, and supplies as in real clinical care. The case was a female in labor who was initially stable with normal vital signs. Progressively, the “patient” became dyspneic, unconscious, and asystolic. A stopwatch measured times. Sessions were videotaped. A blinded reviewer used a validated checklist to determine completion of critical tasks. The Mann-Whitney test compared times between Control and Study groups.
Results: Participants were 96 obstetric nurses, 24 obstetric residents and 24 anesthesia residents. Median time in seconds to start CPR was significantly decreased (Study = 58; Control = 114; P = .01). A trend existed for decreased median time to incision (Study = 306; Control = 341). No difference in time to left uterine tilt existed. Both groups omitted some OBLS tasks (Table 1).
Conclusions: Interprofessional, in situ, OBLS simulation on a large scale is feasible. The study results suggest role assignment decreases time to complete some critical steps. However, gaps in completed OBLS tasks still exist. Future studies will examine the impact of more extensive, repetitive training on closing these gaps.