1. Making healthcare remarkable Have Lucie, will travel: Exploring in situ birthing simulation Stacy Seay Capel MSN, RN, CHSE Culver Nursing Education Lab Novant Health Presbyterian Medical Center Charlotte, NC February 16, 2016

2. With recognition, great appreciation and much affection: Eileen Frager BSN, RNC-OB Lindsey Horne MHA, BSN, RN-MNN Allison Talbert BSN, RNC-OB Teresa Shelton BSN, RNC-MNN

3. Objectives: Provide information and logistics regarding mobile, in situ simulation. Share examples of rosters, audit tools, debriefing reports and post simulation follow-up. Offer participation in preparation for maternal / fetal emergency simulations.

4. Making healthcare remarkable Our history. Serving since 1903.

5. Novant Health Presbyterian Medical Center

6. School of Nursing

7. Margaret Jean Norwood Culver

8. Background: Novant Health (NH) is a regional healthcare provider with: 25,000 team members 13 hospitals 100 outpatient facilities 350 physician practices

9. NH Greater Charlotte Market is located in southern North Carolina and includes three Magnet designated hospitals totaling > 8,300 births/ year: NH Presbyterian Medical Center: 620 beds NH Matthews Medical Center: 146 beds NH Huntersville Medical Center: 91 beds

10. NH Greater Charlotte Market has an established simulation program, including: Mobile simulation unit High fidelity maternal / fetal simulator Multidisciplinary, in situ simulation experience

11. Making healthcare remarkable Our plan. Building on evidence and resources.

12. Regional OB Simulation Objectives: Create and implement a regional obstetric simulation education plan Provide opportunities for women’s services staff to experience high intensity, low frequency simulated clinical emergencies in a safe environment Utilize the planned experiences to promote engagement, team building and process improvement

13. Assesment: In January of 2015 a needs assessment was completed utilizing: risk management statistics review of the California Maternal Quality Care Collaborative staff survey results physician input

14. Action: Three OB emergencies were identified as events that had high staff interest, could safely be replicated through simulation, would impact team practice and patient outcomes: prolapsed cord postpartum hemorrhage intrapartum maternal code

15. Education plans, scenarios and audit tools were designed. Nursing, MD’s, anesthesia, NNP’s, ICN, surgical techs, public safety, chaplaincy services, house supervision, respiratory care, rapid response teams, administration, laboratory services and pharmacy participated in the events.

16. Objectives for Prolapsed cord Code: Identify risk factors for prolapsed cord Recognize actual event Initiate and demonstrate appropriate interventions for a patient with a prolapsed cord

17. Lucie Purple 28YO 168 lbs 5’8 S:The patient is a 28-year-old female being triaged for labor. B: She has had regular prenatal care at her OB/GYN, and has had a healthy pregnancy thus far. Primagravida Allergies: No known drug allergies Medications: None Code Status: Full code Social/Family History: Lives with husband, school teacher A: You are entering the room to assess & complete the admission

18. Objectives for Intrapartum Maternal Code: Recognize symptoms of cardiac arrest Demonstrate timely execution of OBLS emergency skills in a safe environment Practice effective communication between all team members Participate in timing and evaluation of process

19. Lucie Purple 37YO 253 lbs 5’8 S:The patient is a 37-year-old female just admitted to L&D at 38 weeks, 12 hours with ruptured membranes and contractions every 3 to 5 minutes. B: Type I diabetes, has been on bed rest since 32 weeks due to labile blood sugars and preterm contractions. Primagravida Allergies: No known drug allergies Medications: insulin pump Code Status: Full code Social/Family History: Lives with husband, school teacher A: You are entering the room to assess & complete the admission

20. Objectives for Postpartum Hemorrhage: Identify risk factors for PPH Recognize early S & S of post-partum hemorrhage Perform appropriate management of and initiate protocol for PPH

21. Lucie Purple 28YO 160 lbs 5’8 S:The patient is a 28-year-old female 4hrs postpartum B: G4, P4 Had a 2 day induction and gave birth to a 9lb 12oz male. One dose methergine given in L&D. Allergies: No known drug allergies Medications: Flonase & Singulair Code Status: Full code Social/Family History: Lives with husband and 3 other children. She is a school teacher. A: She has called out for assistance & You are entering the room.

22. References: Clapper, T. C. (2013). In Situ and mobile simulation: Lessons learned… authentic and resource intensive. Clinical Simulation in Nursing, 9(11), e551-e557. Jeffries, P.R. (2007). Simulation in nursing education. New York, NY: NLN. Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development (Vol. 1). Englewood Cliffs, NJ: Prentice-Hall. Rudolph, J., Simon, R., Dufresne, R. & Raemer, D. (2006) There’s no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgement. Simulation in Healthcare, 1(1), 49-56. The INACSL Board of Directors (2015, June). Standards. Clinical Simulation in Nursing, 11(6), 309-315. doi:10.1016/j.ecns.2015.03.005

23. Making healthcare remarkable Contact Information Stacy Seay Capel MSN, RN, CHSE scapel@novanthealth.org 704.384.5597