2015 MOREOB Patient Safety Award: Central Canada Zone Winner
Year 1 of the MOREOB Program was a great success for our obstetrical team at the North Bay Regional Health Centre. At the conclusion of Module 1, we were thrilled with our accomplishments and knew we had truly grown as a team. Together, through the various MOREOB team-building and learning activities, our interdisciplinary team reached common ground. We knew we were well on our way to establishing a unit culture where patient safety is the priority.
As our Core Team planned for Year 2 and considered the theme "Working Together", we quickly realized our obstetrical team extends beyond the walls of our Birthing Unit. We acknowledged that our team does not work alone, so we identified the teams we work closely with and prepared to share our success and the principles of the MOREOB Program with them!
The Core Team began by preparing a MOREOB presentation to deliver to other teams within the hospital. Core Team members volunteered to personally share our good news story at team meetings with the Operating Room, Critical Care Unit, Department of Anesthesiology and Department of Pediatrics, to name a few. As we approached the end of Module 2, we wanted to plan a memorable finale that would highlight the theme "Working Together" and involve our facility-wide emergency response teams.
Although maternal cardiac arrest is rare and unexpected, it is extremely devastating for the patient, family and caregivers when it occurs. It is a unique event as there are two patients and multiple teams who do not normally work together yet are required to have amazing teamwork skills. Since several studies have shown a significant lack of knowledge among disciplines about the differences in the resuscitation of a pregnant patient, we decided that an emergency drill such as this would be an amazing finale for Module 2!
After several months of planning, on March 12, 2015, we executed the most complex emergency drill of all - maternal code blue, including perimortem caesarean section, and a subsequent code pink for the newborn.
Our "mega code" required several months of planning and we arranged three formal meetings with key stakeholders. We enlisted members of the interdisciplinary team and our planning group included four RN Core Team members, one obstetrician, one pediatrician, two anesthesiologists, one physician from the Emergency Department, a respiratory therapist and clinical nurse educators from the Critical Care Unit and the Emergency Department. We had informed senior leadership of our elaborate plan and they supported us every step of the way.
The first task was to determine the scenario for our drill. We decided to keep it as simple as possible since in itself. maternal code blue is complicated enough. We set the scene with a pregnant woman in active labour with no risk factors who was found unresponsive. We wanted our drill to include the following components:
- Maternal Cardiac Arrest / Code Blue
- Perimortem C-section
- Code pink for resuscitation of the baby
We planned to make our scenario as realistic as possible. Although we considered using an actress to play the role of the labouring patient, we decided to use a mannequin so chest compressions could be practiced. Unfortunately, our unit does not own a high fidelity mannequin so we used a full body, non-pregnant CPR "Annie" as our patient. We achieved excellent realism with our low fidelity mannequin by creating a pregnant abdomen and attaching it to our "patient". Using low cost materials, we constructed a gravid uterus that was anatomically correct. We simulated the layers of the abdomen with items such as a cream coloured shower curtain for skin, thin foam mattress for subcutaneous tissue and a large red punching balloon for the uterus that contained a baby and water filled balloons to simulate amniotic fluid! We knew this would be impressive when the perimortem c-section was carried out!
Although we had never done a perimortem c-section at our hospital, we acknowledged that it could certainly happen. But were we ready? What was needed? Could we actually deliver a baby by caesarean section within 4 minutes of maternal cardiac arrest? So, with stakeholder input from all obstetricians, we created two identical perimortem c-section kits...one for the Birthing Unit and the other for the Emergency Department. The kits contain all basic instruments and supplies required for the surgical procedure we hope will never happen.
On the day of our mega code, we secretly set the scenario in a labour room. We had a nursing student play the part of the patient's support person who frantically ran into the hall saying "there is something wrong with my wife!" A code blue was called overhead and the designated responders arrived immediately. They promptly began maternal resuscitation and minutes later a perimortem c-section was carried out and a code pink was called to the same location.
We had arranged for several facilitators to oversee and take notes during the code as there would be many important events happening in the room simultaneously. We knew this would be essential to so we could offer a valuable debriefing session after the emergency drill. Clinical nurse educators from CCU and ED and one of the anesthesiologists (who is also the Chief of Staff) observed the maternal resuscitation, an obstetrician facilitated the perimortem c-section and a pediatrician observed the code pink.
Following our mega code, we used the MOREOB debriefing tools to discuss the event with the various responders. During the debriefing, a focus of our discussion was how the physiological changes of pregnancy affect resuscitation and how the immediate delivery of the baby can significantly improve the maternal outcome. In a collegial, educational environment, we discussed what went well and where we could improve. We later compiled a written report and provided it to the team leads and clinical nurse educators, This allowed us to share the event, lessons learned and recommendations with as many members of the interdisciplinary team as possible.
This mega code was a tremendous accomplishment and proved to be one of the highlights of our MOREOB journey thus far. Through this event, we were able to develop effective teamwork and communication, embrace learning, knowledge sharing and evaluation and promote interprofessional collaboration with trust and respect. We are one step closer to achieving the MOREOB Mission!
Our MOREOB core team decided a memorable emergency drill would be a great finale to wrap up Module 2 of the MOREOB Program. We planned and executed a maternal code blue / code pink that involved the resuscitation of a pregnant woman in labour and also the resuscitation of her newborn baby following a perimortem c-section at the bedside! We involved other teams in our hospital and through interprofessional collaboration we provided an outstanding education opportunity for everyone.
The theme "working together" was certainly apparent throughout this entire exercise...right from the planning and facilitation of the event with our colleagues from other departments, to the dedicated responders on the day of the mock code! TOGETHER we continue to create a culture of patient safety...not just for mothers and babies, but for every patient in our organization.