Training for obstetric emergencies

Confidential enquiries into poor perinatal outcomes have identified deficiencies in team working as a common factor and have recommended team training in the management of obstetric emergencies (1). 

In the UK, obstetric emergency training is conducted nationally, for example, Advanced Life Support in Obstetrics (ALSO) and Managing Obstetric Emergencies and Trauma (MOET), as well as locally within maternity units (2).

A systematic review of the literature on the effectiveness of multidisciplinary teamwork training in a simulation setting for the reduction of medical adverse outcomes in obstetric emergency situations, found the introduction of multidisciplinary teamwork training, with integrated acute obstetric training interventions in a simulation setting, is potentially effective in the prevention of errors (3).

When looking at obstetric emergency training programmes from hospitals that have demonstrated improved outcomes to determine the active components of effective training, the common features identified were: institution-level incentives to train; multi-professional training of all staff in their units; teamwork training integrated with clinical teaching and use of high fidelity simulation models (1).

Shoulder dystocia is an unpredictable, acutely life-threatening obstetric emergency, with significant risk of harm to the infant if managed inappropriately(4). Effective and sustainable multi-professional training is crucial in reducing these risks and improving maternity care and safety. Whilst not all multi-professional training works. using the established PROMPT (PRactical Obstetric Multi-Professional Training) programme has resulted in significant improvements in reducing preventable harm following shoulder dystocia, particularly permanent neonatal brachial plexus injury. PROMPT involves low cost, high fidelity simulation training, which is designed to optimise multi-professional team working. It bridges the gap between theory and real-life, providing hands-on practical training. To more accurately reflect real life, individuals train within their usual professional role and training takes place ‘in-house’.

 


References:

1) Siassakos, D., Crofts, J., Winter, C., Weiner, C. and Draycott, T. (2009), The active components of effective training in obstetric emergencies. BJOG: An International Journal of Obstetrics & Gynaecology, 116: 1028–1032. doi: 10.1111/j.1471-0528.2009.02178.x
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02178.x/full

2) Crofts, J., Ellis, D., Draycott, T., Winter, C., Hunt, L. and Akande, V. (2007), Change in knowledge of midwives and obstetricians following obstetric emergency training: a randomised controlled trial of local hospital, simulation centre and teamwork training. BJOG: An International Journal of Obstetrics & Gynaecology, 114: 1534–1541. doi: 10.1111/j.1471-0528.2007.01493.x
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2007.01493.x/full

3) Merien AE, van de Ven J, Mol BW, et al. Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review. Obstet Gynecol 2010;115:1021–31.
http://journals.lww.com/greenjournal/Abstract/2010/05000/Multidisciplinary_Team_Training_in_a_Simulation.23.aspx

4) Draycott TJ, Crofts JF, Ash JP, et al. Improving neonatal outcome through practical shoulder dystocia training. Obstet Gynecol. 2008; 112:14–20.
http://journals.lww.com/greenjournal/Abstract/2008/07000/Improving_Neonatal_Outcome_Through_Practical.6.aspx


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