02/19/19

An OBHG hospitalist on the value of simulation training

The Society of OB/GYN Hospitalists (SOGH) recently talked with OBHG site director Dr. Rhonda Williams about the simulations she has been leading at her hospital program in Baton Rouge, Louisiana.

Tell us about your hospital.

RW: Baton Rouge General Medical Center is a community hospital with seven labor and delivery beds, three OB emergency room beds, and about 10 postpartum rooms. We deliver about 1,000 babies a year. The Ob Hospitalist Group program has been active for about three years.

How has the OB hospitalist team made a difference at your hospital?

RW: The presence of the OB hospitalists has created a culture of safety on our unit. We have helped the unit respond better to emergencies by preparing the staff with a series of educational opportunities and education drills.

We started with skills and knowledge training so everyone was on the same page. For example, identifying and locating instruments and devices on the unit was key. We prepared postpartum hemorrhage medication kits and a tool kit for hemorrhage.

We practice skills quarterly on the unit. Now we are starting to collect data, like how much blood we transfuse, how many patients go to the ICU, and how long it takes to get a physician to the bedside.

Tell us about your simulations.

RW: My favorite simulation was severe hypertension because we added an amniotic fluid embolism and a Code Blue to the simulation, but didn’t tell anyone. It turned out to be a lot of fun, and a real eye opener for our unit.

We added a Code O for OB codes to help us get the right people to the patient quickly. We identify the nurses who are responding during a code by labeling them RN 1, RN 2, and RN 3. One administers medications, one is a recorder, and one is a coordinator. Simulations have definitely improved our team skills.

How did your hospital conduct effective simulations without high tech simulation equipment?

RW: You don’t have to be high tech and have a Noelle to do a simulation if you don’t have money to do that. We trained some of our nurses to be actors for some of the simulations. Our hospital’s Code Blue educators also had a male code blue simulation manikin that we were able to use. He could put up heart rhythms and responses to actions. We added a wig, and then put a MamaNatalie Birthing Simulator on him. MamaNatalie is a pregnancy belly that costs about $900 and we got a grant to buy it.

We asked the nurses to come up with names for the patient and her partner, which was a lot of fun because we have all heard of strange baby names. We also had to find a way to make a manikin “bleed.” We used “him”for our AFE. We relied on various resources like ACOG, AWHOHN and SOGH for information.

Our simulation team included our unit RN educator, RN manager, director of women’s services, OB chairperson, the hospital educator, risk management, and the hospitalists. I went to train the trainer at SOGH, and that helped me personally to guide the process. I also talked to private physicians individually about the need to participate to boost morale on the unit and our teamwork. It was key that we had administration’s strong support to implement safety drills.

I want people to know that smaller hospitals don’t need a sentinel event to make this happen. You need strong nurse management and education to partner with you as the hospitalist.

What was one improvement simulations have made for your unit?

RW: After every simulation, and now every delivery at the hospital, we do a short debrief. We ask what happened briefly, what went well, what did not go well, and what systems issues happened. We collect all of the debriefings in a binder, and we respond by fixing just one thing.

Sometimes it is just a small thing like the pharmacy moved the Pitocin bags so we couldn’t find them easily. When we started fixing things after simulations, people started realizing that it can make a difference on the unit so people have really started writing down what we could do better on the debriefing forms. It really has helped us get buy-in.

Why do you spend your personal time doing this?

RW: I give it my all because I want to improve the quality of care for our patients. It’s a big challenge and takes a lot of work to prepare simulations.

We know what to do in most maternal emergency situations. With practice, preparedness, and teamwork, most maternal mortality can be prevented. We just need to shorten our response and treatment times. Time is life.

This article originally appeared in the Society of OB/GYN Hospitalists January 2019 newsletter.