obstetric emergency communication and teamwork
Post on 14-Nov-2014
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OBSTETRIC EMERGENCY OBSTETRIC EMERGENCY COMMUNICATION AND TEAM WORKCOMMUNICATION AND TEAM WORK
COMMUNICATION AND TEAM WORK COMMUNICATION AND TEAM WORK TRAINING IN MATERNAL EMERGENCIES TRAINING IN MATERNAL EMERGENCIES WORKSWORKSPROCEDURES PERFORMED FASTERPROCEDURES PERFORMED FASTERBETTER OUTCOMES FOR BABYBETTER OUTCOMES FOR BABY
MINDFULNESSMINDFULNESS
Be able to focus your attention on what is importantBe able to focus your attention on what is important
MumMum
BabyBaby
Your teamYour team
LogisticsLogistics
A few mindful breathsA few mindful breaths
IF YOU THINK THIS MAY BE AN IF YOU THINK THIS MAY BE AN EMERGENCY …EMERGENCY …
Declare it “We are going to need some help”Declare it “We are going to need some help”
This gets you staff from the floor in Maty, Paeds, This gets you staff from the floor in Maty, Paeds, CCU, EDCCU, ED
+ Duty Nurse Manager+ Duty Nurse Manager
You can stand them down if not neededYou can stand them down if not needed
THE ORDER WILL VARYTHE ORDER WILL VARY
As help arrives …As help arrives …
80008000
““This is Delivery Room 3:This is Delivery Room 3:
““Immediate Caesar please” orImmediate Caesar please” or
““Immediate obstetrician [and or paediatrician] attendance please” Immediate obstetrician [and or paediatrician] attendance please” oror
““Neonatal resus” orNeonatal resus” or
““Cardiac arrest”Cardiac arrest”
““Please phone me back when you have spoken to the obstetrician”Please phone me back when you have spoken to the obstetrician”
Not dial 0: “paeds resus team to room 3”Not dial 0: “paeds resus team to room 3”
““Cardiac arrest”Cardiac arrest” Day: DNM, CCU RN, 3 RMOs, ED SMO, orderlyDay: DNM, CCU RN, 3 RMOs, ED SMO, orderly Night: DNM, CCU RN, 2 RMOs, orderlyNight: DNM, CCU RN, 2 RMOs, orderly
ASSIGN A TEAM LEADERASSIGN A TEAM LEADER
Not necessarily doctor, not necessarily Not necessarily doctor, not necessarily obstetricianobstetrician
Not necessarily most senior personNot necessarily most senior person
eg Senior midwife, senior RMOeg Senior midwife, senior RMO
May change as more experienced staff arriveMay change as more experienced staff arrive
TEAM LEADERTEAM LEADER
A few mindful breathsA few mindful breaths
Create calm and orderCreate calm and order
Receive handoverReceive handover
Grab a checklistGrab a checklist
Assign roles / tasks to specific staffAssign roles / tasks to specific staff
Hands off, stand back and overseeHands off, stand back and oversee
Direct, double checkDirect, double check
HAND OVERHAND OVER
Clear & ConciseClear & Concise
““This is Jane. Massive PPHThis is Jane. Massive PPH
We have called 8000, Obstetrician is on her wayWe have called 8000, Obstetrician is on her way
Placenta delivered intact. We are rubbing the fundus, vaginal exam is Placenta delivered intact. We are rubbing the fundus, vaginal exam is normal, synto has been given IM, we have sent for O neg.normal, synto has been given IM, we have sent for O neg.
We have no IV accessWe have no IV access
Would you please take over as team leader”Would you please take over as team leader”
I don’t want to know if she is a grand multip and had a prolonged 2nd I don’t want to know if she is a grand multip and had a prolonged 2nd stage.stage.
TEAM LEADERTEAM LEADER
Voice a shared mental modelVoice a shared mental model
““We have a PPHWe have a PPH
We are using the PPH checklist, 8000 has been called, O+G is coming, no IV access, Placental out intact, PV We are using the PPH checklist, 8000 has been called, O+G is coming, no IV access, Placental out intact, PV OK, O neg coming, I am team leaderOK, O neg coming, I am team leader
Mike: Airway and breathingMike: Airway and breathing
Jo: Lines and bloods, and continue to manage “C”Jo: Lines and bloods, and continue to manage “C”
Wiremu: Call the lab and activate the Massive Transfusion ProtocolWiremu: Call the lab and activate the Massive Transfusion Protocol
Anne: Write PPH on the white board then ScribeAnne: Write PPH on the white board then Scribe
Bev: Continue fundal massageBev: Continue fundal massage
Joan: Catheter then bimanual compression pleaseJoan: Catheter then bimanual compression please
etcetc
A few minutes later ….A few minutes later ….
““OK: We are managing a severe PPH, bimanual compression is OK: We are managing a severe PPH, bimanual compression is happening, we have IV access x 2, bloods have been sent, O happening, we have IV access x 2, bloods have been sent, O neg is being hung, Synto is being hung, Misoprostol has been neg is being hung, Synto is being hung, Misoprostol has been given, Massive Transfusion Protocol has been activated. given, Massive Transfusion Protocol has been activated.
““Jane is still tachycardic and hypotensive but mentating OK. Jane is still tachycardic and hypotensive but mentating OK. There is still moderate blood loss. O+G is still on her way. Our There is still moderate blood loss. O+G is still on her way. Our next step is theatre.next step is theatre.
““Wiremu please call 8000 and activate theatre and Wiremu please call 8000 and activate theatre and anaesthetist.anaesthetist.
““We will stay here and continue to resuscitate here until O+G We will stay here and continue to resuscitate here until O+G and theatre are ready. Continue with the Massive Transfusion and theatre are ready. Continue with the Massive Transfusion Protocol.”Protocol.”
CALL AND RESPONDCALL AND RESPONDCOMPLETE THE LOOPCOMPLETE THE LOOPRECORDRECORD
TL: InstructionTL: Instruction
TM: Repeat backTM: Repeat back
Scribe: RecordScribe: Record
TM: Complete taskTM: Complete task
TM: Report backTM: Report back
TL: AcknowledgeTL: Acknowledge
Scribe: RecordScribe: Record
ASK FOR ASSISTANT OR ASK FOR ASSISTANT OR ASSISTANCEASSISTANCE
eg Circulation person will need several assistants to:eg Circulation person will need several assistants to:
get another line in, get another line in,
obtain, share and record obsobtain, share and record obs
label and send bloodslabel and send bloods
to hang blood when it arrivesto hang blood when it arrives
Circulation person is team leader of the circulation sub Circulation person is team leader of the circulation sub teamteam
NAMESNAMES
We often don’t know the members of a resus We often don’t know the members of a resus teamteam
We forget names under stressWe forget names under stress
WEAR A READABLE NAME BADGE - no lanyardsWEAR A READABLE NAME BADGE - no lanyards
It’s OK to say “ED Doc with the big nose”It’s OK to say “ED Doc with the big nose”
EXTRA POINTSEXTRA POINTS
If no obvious team leader ask “Who is team If no obvious team leader ask “Who is team leader?” If no reply “I am team leader”leader?” If no reply “I am team leader”
If you think you would be a better team leader If you think you would be a better team leader offer to take over. Offer usually gratefully offer to take over. Offer usually gratefully accepted.accepted.
It’s OK to say “I don’t know but I will find out It’s OK to say “I don’t know but I will find out and get back to you”and get back to you”
EXTRA POINTSEXTRA POINTS
Have someone write the completed interventions Have someone write the completed interventions on a white boardon a white board
If too many people turn up tell them to wait in a If too many people turn up tell them to wait in a corner/outside/stand them down. corner/outside/stand them down.
Create a culture of Create a culture of
asking for /offering suggestions to team leaderasking for /offering suggestions to team leader
voicing concerns / voicing errorsvoicing concerns / voicing errors
MANAGING DISAGREEMENTMANAGING DISAGREEMENT
• ““Yes … and …”Yes … and …”
• “…“…and on the other hand …”and on the other hand …”
SIMULATIONSIMULATION
Earth’s best 4D simulator is between your earsEarth’s best 4D simulator is between your ears
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