obstetric emergencies training and the impact for interprofessional teamwork
TRANSCRIPT
Obstetric emergencies training and the impact for interprofessional teamwork
Martina Gisin, Midwife expert MSc, BSc, RM
Kyiv 19-20 March 2015
Content
• Obstetric emergencies training – why?
• Incidence maternal of morbidity
• Incidence neonatal of mortality
• Obstetric emergencies training - evidence
• Teamwork
• Impact for interprofessional teamwork
• Example: training session PPH
• Summary
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Obstetric emergencies training- why? I
• Obstetric emergencies are rare, and usually unexpected
• Complications in 1 of 12 deliveries
• High risk situations (high perinatal morbidity and mortality for mother and baby)
• Confusion in the team roles and responsibilities
• Faulty clinical tasks
• Inadequate communication
• Ideal framework to train for critical situations in a safe environment without any risks to patients
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Obstetric emergencies training- why? II
• To improve:
Maternal and perinatal care
Outcomes
Teamwork
Communication
Team roles and responsibilities
Situational awareness
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Increase of the incidence of maternal morbidity 1998 - 2009 • Acute renal failure 3,5 fold increasing rate
• Acute myocardial infarction 2,5 fold increasing rate
• Shock 2,5 fold increasing rate
• Sepsis 1,5 fold increasing rate
• Blood transfusions 1,8 fold increasing rate
(Callaghan et al. 2013)
• PPH (Post partum Haemorrhage) – 27% increase 2000 - 2009 (Mehrabadi et al. 2012)
• PPH is the primary cause of maternal morbidity and mortality. Prevalence: 0.5 - 5% (Surbek et al.2009)
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Incidence of neonatal mortality
• Worldwide: 23% of neonatal deaths are intrapartum related – the incidence is increasing
• England, Wales und Northern Ireland 1993 - 1999 – incidence is decreasing
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Obstetric emergencies training- evidence I
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PROMPT
Obstetric emergencies training- evidence II
• Potentially avoidable:
- 50% of all maternal deaths
- 75% of all intrapartum deaths
• Recurrent source of error:
Not identifying the problem Communication failures Delay in reacting to changed clinical circumstances or failure to recognise a change Delayed or failure to transfer the patient Inappropriate delegation to an inexperienced assistant Lack of multiprofessional team working
(CEMACH 2011, CESDI 2007)
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interprofessional
midwife obstetrician
anaesthetists
neonatologist
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Interprofessional collaboration=Teamwork
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Teamwork
• Correct and clear communication can be life-saving
in emergency situations
• It is important to know the different roles and
responsibilities of team members, and to accept and
to respect them
• A team is only as strong as its weakest link and so
its important that all staff are trained
• To take a step back (helicopter view) to get a better
overview
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Impact of interprofessional teamwork- I SaFE study (Simulation and Fire drill Evaluation) researched the: • Effect of training on individuals and the team • Ability of labor staff to manage acute obstetric emergencies • Local vs. centre-based simulation training
Result: • Clear improvement after skills trainings
Conclusion: • Training verified, improved knowledge and performance • Similar improvement between local training units or
simulation centers • Improvement of knowledge and skills persist for 1 year
(Strachan et al. 2011)
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Impact of interprofessional teamwork- II Comparison of teams with or without training in a medical simulation centre:
• Team performance and medical technical skills may be significantly improved after interprofessional obstetric team training in a medical simulation centre. (Fransen et al. 2012)
Sustainability of the training:
• Strengthening the competences in obstetric emergencies situations
• Strengthening sustainably of professional expertise (subjective view)
• Major change was the optimization of communication (Monod et al. 2011)
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Train together who work together
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Example: training session PPH- I
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Example: training session PPH- II
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Example: training session PPH- III
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Summary
• Obstetric emergencies are rare, and mainly unexpected.
Adequate action from all team members is required
• Critical situations and algorithms can be trained for in a
safe environment without any risk to patients
• The subject-specific competences can be strengthened
sustainably and can improve maternal and perinatal
care in the emergency situation
• «Train together those who work together», a concept of
interprofessional collaboration to improve the safety of
patients in obstetrics and in many other areas 18
Basel Simulation team for obstetric emergencies
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Literature • Callaghan WM, Creanga AA, Kuklina EV (2012) Severe maternal morbidity among delivery and postpartum
hospitalizations in the United States. American Journal of Obstetrics & Gynecology, 120(5):1029-36.
• CEMACH, CESDI & NCEPOD (2011) 8th Annual report of the Confidential Enquiries in to maternal deaths in the UK Clinical Negligence Scheme for Trusts.
• Confidential Enquiry into Stillbirths and Deaths in Infancy (2007)8th Annual report. Focusing on: Stillbirths. European Comparisons of Perinatal Care. Paediatric Postmortem Issues. Survival Rates of Premature Babies – Project 27/28.http://www.bmj.com/content/bmj/suppl/2012/04/03/bmj.e2105.DC1/galc002312.ww2_default.pdf
• Fransen et al. (2012) Effect of obstetric team training on team performance and medical technical skills: a randomised controlled trial BJOG An International Journal of Obstetrics and Gynaecology, 119 (11): 1387- 1393.
• Lawn JL, Kinney M, Lee AAC, Chopra M, Donnay F, Paul VK, Bhutta ZA, Bateman M, Darmstadt GL (2009) Reducing intrapartum-related deaths and disability: Can the health system deliver? International Journal of Gynecology & Obstetrics, 107:123–142.
• Mehrabadi A, Hutcheon JA, Lee L, Liston RM, Joseph KM (2012) Trends in postpartum hemorrhage from 2000 to 2009: a population-based study. BMC Pregnancy and Childbirth, 12:108.
• Monod C., Vökt C., Gisin M., Gisin S., Hösli I. (2011) Simulationstraining in der Geburtshilfe: Erfahrungen am Universitätsspital Basel, Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe SGGG, Jahreskongress in Lugano.
• Strachan B, Crofts J, James M, Akande V, Hunt L, Ellis D, Harris M, Montague I, Draycott T (2008) Proof of principle study of the effect of individual and team drill on the ability of labour ward staff to manage acute obstetric emergencies. Edgbaston, Birmingham: PSRP, Department of Health, Public Health, Epidemiology & Biostatistics, University of Birmingham
• Surbek D, Hess T, Drack G (2009) Aktuelle Therapieoptionen der postpartalen Hämorrhagie (aktualisierte Version vom 3.11.2009). Expertenbrief No. 26, Kommission Qualitätssicherung Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe. http://sggg.ch/files/Expertenbrief_No_26.pdf.
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