Vassar Brothers Medical Center in Poughkeepsie, N.Y., is the first facility in the Hudson Valley region to offer a perinatal simulation program for its staff. Weve provided the opportunity to raise the bar for our staff in terms of learning patient safety priorities and testing out emergency situations before the real thing happens, says Margaret Cusumano, RN, MSN, FACHE, vice president of patient care services and CNO. It gives everyone a feeling of confidence and the ability to work as a team.
After extensive training and preparation, members of the simulation team, which consists of staff and leadership from labor and delivery, mother-baby and the NICU, initiated a formalized program April 1. Using the Noelle Sim model, a high-fidelity simulation model that offers RNs and perinatal technicians the opportunity to practice real-life situations, the team sets up various clinical scenarios that result in maternal code.
Participants are provided with a small vignette of a clinical scenario, and as they interact with Noelle, the scenario, which requires assessment and intervention, unfolds based on participant responses. If they dont respond quickly and correctly, for example, to signs and symptoms of shock, Noelle may have a cardiac arrest, says Susan Shannon Amos, RN, CNM, MSN, director of maternal child health services.
During the training session, there is a didactic component, where staff meets Noelle and reviews what the model can do, including a hands-on assessment of location of pulses and anatomy, the rules of simulation and the principles of crew resource management-based communication. After the scenario takes place, the attendees participate in a formal debriefing session, where the bulk of the clinical teaching occurs in a nonthreatening way.Some of the Vasser Brothers simulation team members are, from left, Susan Amos, RN; Andrea Leggio, RN; Kerrie LaSalvia, RN; Noelle; Winnie Hernandez, RN; Ana Guzman, RN; Sue Field, RN; and Dori Krolick, RN.
Participants review the components of the clinical condition and the critical thinking that led to the decisions that were made. We have received a positive response to our program, and some have attended a second session when they realized that they needed to practice some of the critical skills again, says Wendy McClenahan, RN, nurse manager of labor and delivery.
All members of the perinatal team are required to attend one session, which are offered at different times and days. In order to run the program successfully, members of the simulation team function as observers and physicians, and have been trained to operate the computer system, where condition-specific scenarios are built in the system and can be changed on the fly in response to staff interventions.
Right now we are running various maternal code scenarios, but once everyone has participated in this scenario, we plan to cover other obstetrical emergencies like shoulder dystocia and maternal hemorrhage, Amos says.
Based on the program, administration and staff have evaluated and made recommendations for adjustments to system issues, such as who should open the locked unit doors when a code has been called or when to activate the local vs. the code team. During each simulation session, we like to have a mix of both RNs and perinatal technicians because that is what occurs in a real-life situation, says Dori Krolick, RNC, MSN, FNP-C, nurse manager of the mother-baby unit.
Recently, the simulation team implemented an infant code scenario for the staff in the ED with high-fidelity premie Hal. In the near future, administration and staff hope to offer the simulation program to staff at other facilities in the area.
Editors note: For information on the program, e-mail Amos at [email protected]