A Strategy Proposal for Obstetric Emergencies

A Strategy Proposal for obstetricalal EmergenciesREPORT A STRATEGY PROPOSAL FOR MANDATORY SKILLS AND DRILLS SESSIONS FOR OBSTETRIC EMERGENCIES1Executive Summary1.1 This purpose was carried out following the need for praxiss as identified and recommended by the CEMACH send.1.2 The situation was reviewed in the light of current directives regarding inter- master collaboration. This report depart express the necessity to involve completely obstetric and neonatal rung, ensuring competency and continuous professional development.The report has identified mechanisms suggested for the fundament of obstetric dos in such(prenominal) a way that they be viewed by the voltage participants as a non-threatening mechanism that is highlighting good argonas of practice and areas for advantage.The ferment leave alone stand jointly with a programme of targeted education to address areas of weakness.The process of drills and their feedback impart be monitored and refinements made.This sy stem of risk anxiety will feed into the process areas of concern suitable for drill military rating.2.Rationale for option of Topic motherliness care has been identified as an area for improvement (Department of Health 2000 An Organisation with a Memory). This topic of drills was chosen because there are clear c anys for its use by a number of bodies (these include CEMACH, 1999, the empurpled College of Obstetricians and Gynaecologists Towards Safer Childbirth document and CNST) and it well illustrates the importance of multidisciplinary aggroup working. These drills are a requirement of CNST level 2 which confers a 20% reduction in insurance premiums on trusts. Drills have been of proven benefit in astir(p) performance in eclampsia simulations (Thompson, 2004). It is promising that drills in another(prenominal) areas of obstetrics will in addition lead to improved performance (Thompson, 2004). The midwifery statutory body, the obstetrics Committee of the Nursing and midw ifery Council, and formerly the UKCC are concerned with the lawful updating of eruditenesss requiring at least five days of learning both three years.Humanistic boostThe very nature of improving persevering care for its own sake should be sufficient impetus to bring in an environment receptive to this mixture.The proposal isThe introduction of mandatory adroitnesss and drills sessions for obstetric emergencies whereforeTo involve all staff and ensure competency and continuous professional development. To identify staff who need more(prenominal) training e.g. study days.WHO Midwives and other clinical staff, to encourage professional development and capability to deal with indispensability situations.WHATShoulder dystocia prenatal and post partum haemorrhageEclampsiaUndiagnosed breech exhibitneonatal and Maternal resuscitationPlacental abruptionCNST actually recommends the following drills yearlyCord ProlapseVaginal Breech actors lineShoulder DystociaAntepartum Haemor rhage / Severe postpartum HaemorrhageHOWMonthly skills and drills wobble skill monthly separately drill twice a yearEach midwife to attend a minimum of one of each skill per year3.Critical DiscussionBackgroundThe drills will be a part of evidence-based training through practical skills, on extremity situations occurring in the antepartum, intrapartum and postpartum period to prevent agnatic and neonatal mortality and morbidness (CEMACH). The latest report of the Confidential Enquiry into Maternal Deaths sates that emergency drills for maternal resuscitation should be regularly practised in clinical areas in all maternity units. The clinical Negligence Scheme for Trusts (CEMACH) has Maternity clinical risk of exposure Management Standards. CNST (level 2, April, 2005) Criterion 5.2.1 statesThere is a system in outrank to ensure that all relevant staff participate inan annual skills drill.The CNST documentation advises thatCollaborative, multidisciplinary practice sessions or dril ls, for dealing with emergency situations, allow for all members of staff, specially new and junior staff, to know and understand their specific roles andresponsibilities in an emergency.The CNST also statesCritical contingency analysis is an effective educational and chargetool, and its use should be incorporated into the philosophy and daily care of stab Wards.For CNST satisfaction in this criterion there must be tab records of all those who attend each drill. The rills should be linked to a training programme. There should be at least 75% attendance and ideally 100% attendance.Critical incidents in obstetrics are uncommon. Whilst the risk management already in place may highlight weaknesses in readying of care and remedial measures may consequently be wipe outn such as march on training it is advantageous to simulate these uncommon just acutely life-threatening situations in order to feed the results into the risk management process.Inter-Professional TeamIt is especiall y important that the drills involve the multidisciplinary team. The following members will be regularly involvedMidwivesMaternity assistantsObstetricians of all gradesAnaesthetistsOperating department assistantsPortersNeonatal paediatricians and nursesStudentsIt is important that all the people involved in an actual emergency are considered when context up a drill. In some scenarios the haematology team may be involved following consultation beforehand. The more realistic the drill the more valuable it will prove.StrategyThe proposal consists of a number of aspects (Roberts, 1998) such as assembling a working class team, planning the drills, slaying, evaluation, modification so further implementation of the drills, further evaluation and so on.With regard to strategy introducing drills does not fit so well into there being an agreed process in advance with the likely participants in the drill. This will make the drill less realistic and, especially if the subject matter is know n in advance, it will enable participants to prepare. A fine balance will be sought between gaining the bind of the individuals affected via effective interpersonal sills and leadership to enable an atmosphere of trust. This approach is of proven benefit (Kassean, 2005). This will involve informing the clinicians that drills will take place and the reasons why and that they should enable improvement in practice and team working with emphasis on this being in a non-threatening manner.During initial drills the performance will depend on the abilities, clinical and team working of all the clinicians attending and will also depend on the drill itself. There are two things to evaluate staff performance and the drill itself. The drill can be modified. The weak areas in the performance of staff can be evaluated and training issues made good. On repetition of the drills subsequent staff performance will reflect and can be employ as a measure of the success or otherwise of the implementati on of the drills. DiscussionIt will be important to pay particular tutelage to discussion and accurate planning of the drills. Meetings will be set up involving management and including the Professional Development state of affairsr, Risk Management Officer, Head of Midwifery and clinical Liaison Officer. Although it is proposed to cover the above lists the needs and timing and level of repetition of specific drills will be determined by incident reports. The risk management process will feed into the drill planning. The pedagogy elements will be modified in timing, content and repetition accord to specific performance in the drills. Individual training can then be addressed where needed and captivate and more general sessions also provided with the relevant attendance facilitated. The objective, which will be made transparent, is to maximise the have motivation and effort of all those likely to be involved in the transfigure.Resources neededThere are some resource implicati ons although these are more or less minimal compared to the likely gains. Staff time is involved in setting up the drills. Rooms need to be available. However clinical board will be used for instance (but not confined to) the delivery suite when it is quiet. Standard equipment will be used and this will witness costs. It may be prerequisite to purchase models or these may already be available on the unit. Some handouts may be necessary and documentation will need to be kept of attendance registers and the progress and evaluation of the drills.Management of changeThere are many change theories. Particularly illustrative of the inertia to change is a major component part of Lewins (1951) theory of change. Here people are frozen in a particular manner of doing things. There are many reasons for this stern position. Whilst some of the reasons relate to external factors the crucial resistance to change is at the level of the individual. In order for the individual to change, their way of thinking near the factor needs to be addressed. to a fault much pressure moreover can make an individual more resistant to change (Broome, 1998). Too many stressors will decrease the level of performance (Broome, 1998). An example of a successful change implementation emphasised the importance of confabulation at this stage in the change process (Kassean, 2005). Once the individual accepts the reasons for the change rather than just that change is necessary they can make the change, then further freezing in the new position effects the change. estimable and legal considerationsMidwives must be accountable for the actions and they have a art of care to be up to date with their training. There are fitness to practice issues inherent here. Dimond (2006) describes the outcomes of some recent legal cases concerning interdisciplinary communication and management of obstetric emergencies. Evidence of team working and adherence to appropriate guidelines will help in the defence of such problems.The process of drills and further training and repeat drills will help to create a learning culture (Garcarz, 2003). Burke (2003) compares their own study of the effectiveness and the subsequent changes in practice following drills to large awards where delivery was less timely than in their drills.EvaluationFeedback will be obtained in a variety of formats including questionnaires and in reflective practice interviews. This will enable qualitative data to be obtained and analysed. Quantitative data will be obtained and statistically analysed. This evidence will be used to evaluate just how effective the drills and the associated training are in improving clinical practice and team working in the simulation environment. Informal feedback will be acquired from discussion in team meetings of those involved in the drills as trainers and trainees. Such feedback will be assistive in assessing problems not identified elsewhere and will also be illustrative of the real b arriers to change and how these might be addressed.4.ConclusionThe introduction of obstetric drills is mandatory for CNST level 2 and is also recommended practice from a number of other bodies. There is evidence in the literature that such drills can be introduced in a manner which is accepted by participants and which is effective in the subsequent improvement of performance criteria.5.ReferencesBroome A 1998 Managing Change 2nd Edition. Basingstoke, MacmillanBurke C 2003 Scenario training how we do it and the lessons we have learned. Clinical risk 9 103-6CEMACH WWWhttp//www.cemach.org.uk/publications/WMD2000_2002/wmd-intro.htm accessed 23 April 2006-04-23Clinical Negligence Scheme for Trusts MaternityClinical Risk Management Standards April 2005http//www.nhsla.com/NR/rdonlyres/EE1F7C66-A172-4F0C-8A36-7FCCD31A52A0/0/CNSTMaternityStandardsApril2005final.pdf accessed on 23 April 2006Clinical Negligence Scheme for TrustsCNST WWWConfidential Enquiry into Maternal Deaths in the fall in Kingdom 1999 Why mothers die. London Royal College of Obstetricians and GynaecologistsDepartment of Health 2000 An brass section with a memory. Report of an expert group on learning from unfavourable events in the NHS, chaired by the Chief Medical Officer. London Stationery OfficeDimond B 2006 Legal Aspects of Midwifery, 3rd edition. Butterworth-Heinneman, UKGarcarz W Chambers R Ellis S 2003 Make your wellnesscare organisation a learning organisation. Radcliffe. OxfordKassean HK Jagoo ZB 2005 Managing change in the nursing handover from traditional to bedside handover a case study from MauritiusBMC Nursing 2005, 41 1472-6955Lewin K 1951 Field Theory in Social Science. new-fangled York Harper and RowRoberts K Ludvigsen C Project management for health care professionals Butterworth Heineman OxfordRoyal College of Obstetricians and Gynaecologists 1999 Towards safer childbirth. London RCOGThompson S Neal S Clark V 2004 Clinical risk management in obstetrics eclampsia drills BMJ32826 9-271