As a care provider, what would you do if a patient who was suffering from severe preeclampsia at 37-weeks gestation suddenly went into cardiac arrest inside her hospital room?
During a simulation exercise at BWH’s Center for Labor and Birth earlier this month, a team of anesthesiologists, obstetricians and nurses confronted this question and others like it. Together, they practiced what to do in this scenario using a mannequin in an empty patient room, which allowed them to keep their focus sharp and skills fresh for when an uncommon, but real emergency arises
BWH anesthesiologist Michaela Farber, MD, along with Julian Robinson, MD, chief of Obstetrics, began running the multi-disciplinary simulations on CWN-5 more than a year ago. The simulations represent situations on the floor that the team does not see on a daily basis, such as post-partum hemorrhage, malignant hypertension or cardiac arrest.
“These drills are tremendous teaching tools that enhance the quality of care that we provide to our patients who are pregnant,” Farber said. “You can never have too much exposure to crisis management in this field.”
The drills, which take place a few times a month, always involve at least one anesthesiologist, nurse and obstetrician.
Farber and Robinson, the drill directors, begin by bringing the team up to speed on a patient’s case. As the drill plays out, the directors will stop at certain points and talk with the team about what is working and what could be improved.
During the last drill, the team identified that the patient had experienced a reaction to magnesium— a medication given intravenously to expecting mothers with preeclampsia to help prevent seizures.
They also practiced performing resuscitative measures on the patient, including CPR, and ran through the steps they would take if resuscitation was unsuccessful after several minutes.
Anesthesiology, Perioperative and Pain Medicine resident Ilan Mizrahi, MD, participated in the drill earlier this month, and said these exercises are useful because they help to clarify team members’ roles in various situations.
Carolyn Cline, MD, an OB/GYN attending who has been on staff at BWH for the past 23 years, has participated in several drills during her time, both on and off-site, and has found them to be an effective way to reinforce the communication among team members during a crisis event involving a patient.
“The simulation aspect adds some pressure and reality that you can’t get in the classroom or by reviewing cases,” she said.
Pamela Wickett, BSN, RN, Neonatal Resuscitation Program coordinator for Labor and Birth, said that the simulations are important because a nurse is often the first person a patient tells his or her health concerns to: “It is critical that a nurse’s assessment skills are keen so he or she can move forward with the appropriate interventions and call the necessary people to help. Practicing as a cohesive team helps us care for patients more effectively and ensure better outcomes.”
It’s important to stay on the cutting edge as BWH sees a high volume of high-risk OB/GYN patients, said Farber.
“It’s a privilege for us to make staff feel more comfortable managing these situations, which helps us deliver even better care,” she said