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