Creating a Highly ReliablePerinatal Service

Natividad Medical CenterSalinas, Ca

Multidisciplinary teamat morning hand off

Communication- our quest is to be a team that has a shared understanding of what is going on Communication is an essential component of

perinatal teamwork and has a significant impact on the risk of adverse outcomes

We use consistent and mutually agreed upon language to describe FHR patterns and to develop mutually expected interventions based on those patterns- NICHD terminology

Formal Briefings at designated Times: 0800; 1130; 1700; 2300

Sets the tone for the day Discuss procedures, unexpected changes in the

care process Everyone knows the game plan, we are on the

same page Make sure the situation is owned by the entire

team The team includes oncoming and outgoing Family

Medicine and OB, residents, L&D RNs, The L&D Charge RN and the Mother/Baby Unit charge RN

Formal Briefings at Designated Times

Provide meaningful background, stick to facts

Talk about next steps Encourage ongoing

monitoring & cross-checking: it’s everyone’s responsibility to maintain situational awareness

Supervising RN – L&D

Charge RN – L&D

Oncoming OBOR duty

Mother/BabyCharge RN

L&D RN

Sleepyresident

Off going OB gettingready forboard rounds

OB inclinic

Family Medicine physicianL&D RN

OB physician

Oncoming OB

CRNAOn for 24 hrs1st year

resident

Off going OB

“Let me tell you about last night!”

Five Components to Multidisciplinary Rounds

Timely briefings: 0800; 1100; 1700; 2300 Courtesy Review labor curve Clear Communication:

SBAR “I need clarity” – used to stop an event or clarify

plan of care Consistent use of NICHD terminology when

reviewing FHR during board rounds

Natividad’s Process

All team members gather on time Each patient’s case is discussed, the FHR

monitor strip is reviewed using NICHD terminology

Be brief, complete, RN shares current information with team

Even the private physicians present their patients as part of the team and review the fetal monitor strip

Even the private physicians attend board rounds and report on their patients.We are all on the same page

Labor and Delivery Charge RN

Keeps track of each member that attends board rounds

Documents the category of each strip reviewed

Commitment

The entire team is committed to being a part of the communication process

Efficient situational awareness is owned and practiced by the entire perinatal team

On-going updates, cross-talk, cross-checks, verifying that the entire team knows what is happening

The entire team knows what should happen next

Our champion – Dr Peter Chandler