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OB emergency simulations help Saint Clare’s nurses stay prepared

Monday June 9, 2014
Pat Kinney, RN, (at left) records the actions of the drill participants while Louisa Lai, RN, and physician Mike Venanzi take part in a recent birthing simulation.
Pat Kinney, RN, (at left) records the actions of the drill participants while Louisa Lai, RN, and physician Mike Venanzi take part in a recent birthing simulation.
(Photo courtesy of Saint Clare’s Health System)
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Saint Clare’s Health System in Denville, N.J., is using birthing simulators to prepare its labor and delivery nurses for emergencies such as shoulder dystocia.
The Saint Clare’s Foundation recently purchased two high-tech simulators, a mom named Noelle and a baby named Hal, for the maternal-child department.

“Shoulder dystocia is an obstetrical emergency,” said Jennifer Waters, RN, MSN, NE-BC, director of maternal-child nursing. “And because we have 1% incidence of shoulder dystocia each year, it was important to prepare the team with simulation drills.”

An obstetrical emergency simulation team was formed with nurses who had clinical expertise, an ability to navigate computer systems and were active members of the unit nurse practice council, including Margaret Frick, RNC-NIC, BSN; Patricia Kinney, RNC-OB; and Erika Naranjo, RN, MSN. The team chose shoulder dystocia delivery as the initial simulation drill because it is an emergency situation that cannot be predicted.

The team traveled to Miami to visit Gaumard Scientific, the company that created the simulators, for four days of training. The team then trained for two months at Saint Clare’s.

After a scenario was created, the nursing staff, OB physicians and pediatric hospitalists were invited to participate in the drills. Anesthesiologists, respiratory therapists, pediatric hospitalists and OB physicians all attended, or plan to attend drills later this year.

“The drills were lifelike and realistic,” team member Gina Schoch, RNC-OB, said. “The stress and energy in the room was real. A few days after the drill, we had an actual shoulder dystocia. Thanks to the simulation drills, everything went smoothly and everyone in the room knew their role.”

The labor and delivery team also has been working with Hal, a baby simulator, as part of Saint Clare’s neonatal resuscitation program. The American Academy of Pediatrics has changed its NRP to reflect the value of reality-based scenarios and hands-on instruction to improve implementation of evidenced-based practices and delivery of standardized NRP guidelines.

“Challenges were effectively addressed by the high level of energy from each team member’s passion and commitment to improving practice and processes during obstetrical emergencies,” Frick said.

The simulation team has created multiple emergency scenarios for neonatal resuscitation. These scenarios also are used during OB emergency shoulder dystocia drills.

Once the baby is delivered at the drill, it is taken to the warmer and resuscitated as needed, which adds to the reality of the scenario for nurses.

Team members said an additional skill that has emerged is the emotional care for the mother during the emergency delivery.

The simulations, according to team members, have resulted in improved communication, delineation of roles in emergency situations, optimal use of resources and improved outcomes for patients.

“I am impressed with simulation because it allows hands-on experience with the emergency situation before you encounter it in an actual patient situation,” said Kathy Machuga, RN, a mother-baby staff nurse.

The simulations also were used as a research project by labor and delivery nurses Amy Flynn, RN, and Kristina Agudelo, RN, BSN, during work on their bachelor’s degrees. They conducted pre- and post-test questionnaires on how nurses felt about simulation and communication before and after the drills.

Amy Hrdy, RNC-OB, is a clinical nurse educator, maternal-child, at Saint Clare’s Health System.


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