Linda Daniel

Integrating Team Training Strategies into Obstetrical Emergency Simulation Training

Abstract: Successful management of obstetrical emergencies such as shoulder dystocia requires the coordinated efforts of a multidisciplinary team of professionals. Simulation education provides an opportunity to learn and master simple as well as complex technical skills needed in emergent situations. Team training has been shown to improve the quality of communication among team members and consequently has an enormous impact on human performance. In the healthcare environment, especially obstetrics where the stakes are high, integrating team training into simulation education can advance efforts to create and sustain a culture of safety. With over 7,100 deliveries annually, our 1,100‐bed, two‐hospital regional healthcare system embarked on this journey to advance the culture of safety.

Improving the Delivery of Care to Limited English Proficiency Patients

Poster Presentation Purpose for the Program Limited English proficiency (LEP) creates challenges for effective communication, affects health outcomes, and exacerbates health disparities. A survey of postpartum women at this facility indicated that 41% of LEP patients reported an unmet need for an interpreter and wide use of unqualified interpreters during their stays. Proposed Change By October 2013, to achieve a 50% reduction in the number of postpartum LEP women who reported an unmet need for a qualified medical interpreter (MI) during their hospital stay. Implementation, Outcomes, and Evaluation A Lean Six Sigma (LSS) project was initiated to improve the quality and safety of care for women with LEP during their labor and delivery hospitalizations. Utilizing LSS concepts, a multidisciplinary team embraced the define, measure, analyze, improve, and control (DMAIC) process. Focus groups and surveys were conducted to elicit the voice of the customer from patients, nurses, and providers. Findings from a postpartum survey served as the baseline of measure for unmet needs for an interpreter in LEP patients. The number of patients with a completed “preferred language” field in the patient registration and billing system (PRBS) as well as use of qualified interpreters (in person and telephonic) were tracked. A standardized process (script) for soliciting the patients preferred language was established and education on race, ethnicity, and language was provided. Obstetric providers received training on the use of language services and effective communication. After training, there was a 25% increase in completed preferred language fields in PRBS. There was a significant increase (34%) in the use of qualified medical interpreters (p Implications for Nursing Practice Effective communication is critical to the delivery of safe, high‐quality care. Identifying and delivering safe, high‐quality care to patients with LEP can be challenging. Failure to address language barriers inadvertently affects health outcomes. National efforts are underway to address disparities in care. As direct care providers, nurses must appreciate the importance of providing culturally sensitive care to avoid miscommunication and misunderstanding. Nursing administrators need to recognize the challenges associated with caring for the LEP patient and advocate for appropriate support and resources to meet the needs of LEP patients and health care providers.

Use of Triple I Classification System to Manage Early-Onset Sepsis

a 2018 AWHONN, the Association of Women’s Health, Obstetri Published by Elsevier Inc. All rights reserved. implementation of glucose-gel use (n1⁄4 394) and 6 months after implementation of glucose-gel use (n 1⁄4 375). Before implementation of glucose gel, 133 babies experienced hypoglycemia. Babies with only one episode of hypoglycemia were excluded, leaving 65 babies with additional episodes of hypoglycemia. After implementation of glucose gel, there were 126 babies who experienced hypoglycemia and 57 had additional episodes of hypoglycemia. Sixty-two babies required only one dose of glucose gel. The number of NICU admissions decreased from 11 to 4.

Reducing Cesarean Deliveries in Low-Risk, Nulliparous, Term, Singleton, Vertex Women

Professional Issues Poster Presentation Purpose for the Program To reduce cesarean deliveries in nulliparous, term, singleton, vertex (NTSV) women by 10% during the next 18 months from 28.3% to 25.5%. Proposed Change To train a multidisciplinary team in rapid process improvement (RPI) techniques and promote the use of quality tools to plan, prioritize, and execute rapid cycle testing to empower team members to actively participate in successful quality initiatives. This lays the foundation to build a culture of continuous quality improvement. Implementation, Outcomes, and Evaluation Reducing cesarean rates in NTSV women is a perinatal quality measure endorsed by the National Quality Forum (NQF) and The Joint Commission (TJC). In 2014, TJC is mandating hospitals with more than 1,100 deliveries per year to report this quality indicator (PC-02). When we began this process, our cesarean rate in NTSV women was 28.3%. A multidisciplinary team convened to participate in a 90-day RPI program. The team established a goal to reduce cesareans in NTSV women by 10% (25.5%) during the next 12 to 18 months. By using tools provided in the RPI program, the team collected baseline data, mapped current and ideal flow processes, completed a cause and effect analysis (Fishbone diagram) and priority impact matrix to determine what initiatives to focus on first. Administrative support was secured. Oxytocin order sets were standardized. A minimum Bishop score of greater than 8 was mandated to schedule an elective induction. Widespread educational efforts were set in motion, including a Grand Rounds presentation on Preventing the First Cesarean Delivery. Nurses were educated on calculating Bishop scores, order set changes, benefits of laboring down, and the importance of complying with existing guidelines. Ideas solicited from our Family Advisory council fostered community educational efforts that promoted the importance of completing the full 40 weeks of pregnancy. In July, 2013 (7 months into this initiative), our rate was 26.3%, which demonstrated a 7% reduction in the cesarean rate. Hospitalist and resident staff (early adopters) who embraced an evidence-based labor algorithm realized a 14.8% reduction in the cesarean rate (27% down to 23%), and NICU admissions for NTSV deliveries decreased 18% (17.1–13.9%) for our early adopters. It is critical to fully understand processes and collect complete baseline data to effectively target interventions for the greatest effect. Future efforts will focus on medically induced patients. Implications for Nursing Practice It is essential to involve frontline staff and set clear expectations to promote evidence-based practices. Valuable quality tools exist to guide and sustain quality improvement endeavors.