2014 MOREOB Patient Safety Award: United States Winner
As the Kress Birthing Center continues on their journey into Module II we wanted to spread components of the program with another department. The decision was made to collaborate with the Emergency Department (ED). Two topics, Imminent Birth and Hypertension in Pregnancy, were chosen for our Spring 2014 Workshop that would include education that would be pertinent to Maternity and ED departments personnel. For the purpose of this application, Imminent Birth will be the main focus.
- Collaborate with the ED to promote the founding principles of the MORE°B Program and High Reliability Organization.
- Provide an educational program to the Maternity and ED departments to enhance subject knowledge and simulate training in a team setting for an imminent birth.
To gain buy-in from the ED, members of the MOREOB Core Team met with the Green Bay ED Medical Director, Team Leader, and Nurse Educator. The Medical Director strongly believed in the approach of this safety initiative and agreed to co-present with labor nurses on the topic of imminent birth at the Spring Workshop. The ED Team Leader and Educator coordinated attendance at the Workshop by the ED personnel.
Collaborative planning between the ED Medical Director and several labor nurses led to the following objectives:
- Management of imminent birth
- Recognition of the signs of imminent birth
- Identify risks associated with imminent birth (examples: nuchal cord, shoulder dystocia, and management of the third stage of labor)
Following the Workshop an ED Team Facilitator from the Bellin Health Oconto Hospital ED requested that the team present the workshop for their staff. The entire Module II Workshop was provided to the team which included ED physicians, mid-levels, nurses and emergency medical technicians. Immediately after the Workshop, the presenters worked with the Oconto ED team to review their emergency delivery and neonatal resuscitation supplies which were subsequently updated to be consistent with the Green Bay ED.
In follow up to the Module II presentation, two members of the Core Team traveled to the Oconto Hospital ED and ran an imminent birth emergency drill. Refer to the attached nomination form for an internal award that was submitted by a member of the Oconto team. We are currently discussing providing yearly education to staff at the access hospital and continuing to run emergency drills.
Following the Workshop, a member of the MORE°B Core Team met with the Green Bay Hospital ED Educator and Team Leader to schedule emergency drills. In our discussions it was decided that it would be beneficial to develop a group broadcast announcement over our communication system, Vocera. The Vocera Coordinator assisted to immediately implement a group broadcast that is now initiated by an ED nurse in the event of an imminent birth. What this means is that one quick broadcast message will be sent to all of the ED and Maternity staff to alert all of an imminent birth occurring in the ED. This expedites a rapid response from the Maternity Department to ED to assist with the imminent birth.
In continuation of the educational plan, the Maternity staff was educated with a map of the ED and the location of their OB/GYN cart in their department. The expectation was that all Maternity staff familiarize themselves with the ED by visiting the ED, reviewing the room set up and identifying where supplies are located (please refer to attachment). Education included the roles and responsibilities of Maternity staff during an imminent birth in the ED. The ED Educator instructed staff on their roles such as initiating the Vocera broadcast, obtaining the OB/GYN cart and other emergency supplies needed to respond to an imminent birth.
Emergency drills were completed after the above education. The emergency drills allowed the two departments to train together as a team, identify what additional supplies are needed in the ED and verify that the Vocera broadcast was functioning as expected.
After the completion of four drills, the ED had a real life situation when a 24-26 week gestation pregnant women entered the ED and precipitously delivered. After the event debriefing, the team identified additional enhancements to the ED supplies to be made available.
We continue to include our multi-department work with ongoing skills and emergency drills and modification of with location of supplies in the ED. Each time a drill occurs, learning occurs and this has improved our ability to give timely, safe care in an emergent situation. We completed another emergency drill today and will continue to work collaboratively with the ED, including holding emergency drills within the two departments regularly.
Collaborating with the multiple Emergency Departments within Bellin Health will continue to benefit our Moms, babies, their families and staff. Through continued emergency drills and discussion with the ED we will work together to assess, modify, standardize and evaluate how to improve current practice and implement processes that will improve the safety of care provided to our patients.