Implementation of a High Fidelity Post Partum Hemmorhage Simulation for an Acute Care Multisite, Interprofessional Women and Childrens Service Line Improves Patient Care Outcomes
Laura Wining MSN, CHSE, CAPA, CHPN, Coordinator of Education Programs-Simulation; Tracy D. McGuire, MSN, RNC-HROB, C-EFM, FM, Clinical Education Nurse-Women’s and Children’s Service Line
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- International Nursing Association for Clinical Simulation and Learning (INACSL)
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A large hospital system in Colorado where 3500 women deliver each year provided 45 simulation sessions for 195 registered nurses, 34 obstetricians and anesthesiologists, and 24 surgical techs. Simulations were provided in situ and included 4 RN’s, 1-2 physicians, and 1 surgical tech. Simulations began in a patient room and progressed with transfer and treatment to the operating rooms. Simulations followed INACSL Standards of Best Practice: Simulation(SM). Team objectives included initiating early warning blood loss criteria, coordinate care, demonstrate early crew resource management, closed loop communication, equipment locations, medication management, and blood administration in an acute massive transfusion situation. Electronic medical record abstraction through qualitative chart review pre and post education found neonatal deliveries increased from 1788 to 1790, with an increase of 78 to 82 quantified PPH . The number of patients that requiring only medications increased to 60 from 52, patients that required surgical interventions decreased from 27 to 20, and patients needing transfusions decreased by 50% from 18 to 9. Additionally simulations identified process improvements that included supply location changes, additions to a massive transfusion protocol, and implementation of the Early Blood Loss Intervention protocol. Supportive documentation received from physicians post education stated improvement in team performance during patient actual PPH situations. Barriers included competing organization needs that limited some physicians’ involvement, and process differences between hospital sites. interprofessional in situ simulation education is an effective modality to improving patient care outcomes as well as identifying process improvement opportunities by hardwiring early intervention for PPH complications.
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