Nurses are playing a vital role in a new critical care response team at Howard County General Hospital in Columbia, Md. They are players in a unique multidisciplinary lineup called the OB Stat Team, which mixes critical care know-how with the special expertise needed to care for obstetric and maternal/child emergencies.
The OB Stat Team, which officially kicked off this month, is the first team of its kind in the Johns Hopkins Medicine system. The team's goal is to intervene before an actual emergency by assessing and stabilizing obstetric and maternal child patients and assisting with communication, education, support, and transfer.
"This team brings together many individuals that specialize in different areas," says Digna Wheatley, RN, MHA, risk manager at Howard County. "Because the OB Stat Team is multidisciplinary, and everyone has a specific role, everybody feels a sense of relief to have all these different players present."
The OB Stat Team is made up of two sub-teams, Alpha and Bravo, that are activated by the facility's paging system. An Alpha Team page is called for emergencies, such as antepartum/postpartum eclamptic seizures or uterine rupture, within or outside the labor and delivery unit. It also is activated for deliveries that occur outside the unit, such as in a lobby.
Alpha Team members include the labor and delivery charge nurse, anesthesiologist, obstetrician, obstetrical technician, pharmacist, unit secretary, respiratory therapist, lab personnel, and security. A chaplain is a member of the team and acts as a liaison between the patient's family and the team. A neonatologist is also notified of the situation.
The Bravo Team is called for life-threatening antepartum/postpartum hemorrhage. Alpha emergencies can also potentially turn into Bravo emergencies.
The Bravo Team includes members of the Alpha team as well as a second anesthesia provider, as needed, and neonatology services. The administrator on call and an OB/Gyn oncologist are notified as well as a perinatologist, a pathologist, and the blood bank staff. An OR team is on call for surgical support.
In conjunction with the Bravo Team, the facility also has developed a massive transfusion protocol, and there are plans to activate use of the team for any situations in the hospital in which hemorrhage is occurring, such as for trauma or surgical patients.
Nurses in the Mix
The OB Stat Team plan of action often begins with the nurse at the bedside. After assessing and recognizing an impending hemorrhage or potentially serious obstetric condition, they confer with the charge nurse and/or the physician to make a decision to activate the OB Stat Team. If the emergency is outside the labor and delivery unit, the L&D charge nurse will report to the location with a neonatal drug box and a born-out-of-asepsis kit.
"The L&D charge nurse also assesses the patient and acts as team leader until the OB house physician arrives," says Ellen Thompson, RNC-OB, MSc, BSN, C-EFM, OB clinical education program manager. "She also assures that the appropriate Alpha or Bravo team members have arrived."
The patient's primary RN documents the event on the OB Stat Team record. A summary report of the event is completed and includes a checklist that documents if all members arrived promptly, if all equipment needed was present and working properly, and if communication between department personnel and team members was effective and efficient.
"The report is used as a debriefing tool to evaluate how we responded," says Wheatley.
Forms used by the OB Stat Team were adapted from forms currently in use by the hospital's Rapid Response and Code Blue teams.
"The staff is familiar with them already and there's no new learning curve with them," says Wheatley, who adds outcomes data from OB Stat Team activations will be collected, monitored, and used to help advance process and quality improvement.
Practice, Practice, Practice
Drills are an important part of the OB Stat Team's game plan, and a series of four drills helped identify needs and areas for improvement before the team's kick-off.
"We have learned a lot about communication, process, and equipment issues and have been able to address them," says Thompson.
For example, the team learned it needed to have more efficient access to obstetrical medications in an Alpha alert, so a pharmacist was added to the team to bring and mix medications.
During one drill, in which a visitor had an eclamptic seizure in the main lobby at 5 a.m., team members found a crash cart was needed in a more accessible location near the lobby. Other drills included patients with postpartum hemorrhage, placenta previa with hemorrhage and emergency C-section, and a delivery in the ED.
"When these emergencies happen, it can be chaotic, but the drills clarified in our minds what issues we need to focus on," says Grace White, RN, BSN, RNC, a labor and delivery staff nurse and adjunct clinical faculty at The Johns Hopkins School of Nursing, Baltimore. "One of the biggest benefits of the team is the clearly defined roles of team members."
Catherine Spader, RN, is a contributing writer for Nursing Spectrum.
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