References

ProgramContentBackground PlanningandImplemen8ngtheProgram

Se;ngandScopeofProgram

•  With the emerging prevalence of freestanding emergency rooms (ERs), obstetric (OB) patients are seeking emergent care in settings with no in-house OB support

•  Emergency Room (ER) nurses are expected to provide complex care to pregnant patients with minimal experience in obstetric care outside of nursing school (1)

•  Lack of OB knowledge from ER nurse in caring for a obstetric patient presents a potentially dangerous situation to mother and fetus (3)

•  Perinatal nurses’ expertise is a valuable resource educating ER nurses on proper OB assessment and stabilization knowledge and skills (3)

•  Freestanding ER nurses across Ochsner System conveyed to nursing leadership their discomfort in caring for obstetric patients due to :

•  Lack of experience in caring for obstetric patients •  Outdated knowledge of stabilizing mother and fetus •  Limited resources readily available to the ER nurse

•  Due to the increased volume of freestanding ER locations in the Ochsner System,

•  The OB Patients in Unexpected Places education program is taught by an experienced perinatal RN to educate the ER nurse on how to care for the obstetric patient prior to transferring to facility with in-house obstetrics.

•  Didactic content from evidence based literature includes:

•  Anatomy and physiology of pregnant patient

•  Assessing the pregnant patient; history of care, membrane status, contractions

•  Assessing fetal status, heart tones, movement, positioning

•  Stages of labor, techniques to reduce pain

•  Intrauterine resuscitation measures •  Obstetric emergencies:

•  Pre-eclampsia/Eclampsia •  Hemorrhage (placenta

conditions, uterine rupture, postpartum hemorrhage)

•  Prolapsed Cord •  Precipitous delivery •  Code Blue

•  Using mannequins, ER nurses practice new OB skills with one on one instruction from a perinatal nurse

•  Simulation drills allow ER nurses to practice scenarios in their own environment helping them to uncover process, medication or equipment issues

•  Competency is assessed using teach back, return demonstration and simulation debriefing

•  Mandatory classes are held at the freestanding ER facility •  Class is approximately 3 hours with an ideal ratio of 2

teachers to 12 ER nurses •  Obstetric instructors are:

•  Labor & Delivery nurses with at least 5 years of experience

•  Preferably nurses with teaching experience •  Power Point with illustrations in which each instructor

covers their assigned section •  Handouts of algorithms for Pre-Eclampsia and Hemorrhage •  Skill stations:

•  Assessing uterine contractions by palpation •  Assessing fetal heart tones with a Doppler •  Leopold’s maneuver

•  Example of simulations to run: •  Precipitous delivery •  Newborn care immediately after delivery •  Eclamptic seizure •  Postpartum hemorrhage

1) Blake, C. (2012). Did you just say . . . the baby’s coming!!?? A nurse’s guide to prepare for a safe precipitous delivery in the emergency department. Journal of Emergency Nursing, 38(3), 296–300. doi:10.1016/j.jen.2011.07.002 2) Chagolla, B.B., Keats, J.P. & Fulton, J.M. (2013). The importance of interdepartmental collaboration and safe triage for pregnant women in the emergency department. Journal of Obstetrics Gynecology Neonatal Nursing, 42(5), 595-605. doi:10.1111/1552-6909.12238 3) Keough, V.A. (2009). Emergency Care of the Pregnant Patient. Journal of Obstetrics Gynecology Neonatal Nursing, 38 (6), 703, doi:10.1111/j.1552-6909.2009.01071.x 4) Ruffolo, D.C. (2009). Trauma Care and Managing the Injured Pregnant Patient. Journal of Obstetrics Gynecology Neonatal Nursing, 38 (6), 704-714, doi: 10.1111/j.1552-6909.2009.01072.x 5) Kerner, R.L., Gallo, K., Cassara, M., D'Angelo, J., Eagan, A. & Simmons, J.G. (2016). Simulation for Operational Readiness in a New Freestanding Emergency Department. Society for Simulation in Healtcare, 11(5), 345-356, doi:10.1097/SIH.0000000000000180

“I don’t know anything about birthing babies!” Educating Freestanding ER Nurses on Caring for the Obstetric Patient

Jenifer Ducoing, RNC-OB, Mary Emmons, BSN, RNC-OB, Robin Winebar, MSN, RN, CNL