Chapter 42 – Setting Up and Running Labour Ward Fire Drills




Abstract




Key Areas Where Labour Ward Fire Drills May Be Used





Chapter 42 Setting Up and Running Labour Ward Fire Drills


Jia Yan-Ju and Edwin Chandraharan




Key Facts


Definition ‘Labour ward fire drills’ refers to the use of simulation of obstetric emergencies within the labour ward to ensure effective communication and multidisciplinary and multiprofessional team working in order to promote good practice as well as to identify and rectify individual and system factors so as to optimise the clinical outcomes.


All obstetricians and midwives as well as the multidisciplinary team providing maternity care need to appreciate that




  • Substandard care may account for approximately half of all maternal and perinatal deaths.



  • Failures in effective communication, team working and leadership during emergencies contribute to poor outcome.



  • Obstetric emergencies cannot always be anticipated, but the impact of these adverse events can be decreased with the use of training through simulation.



  • Simulation refers to the recreating of real-life clinical scenarios.



  • ‘Fire drill’ programmes using simulation of patients and clinical scenarios are useful for training doctors, midwives and allied staff to manage critical emergencies effectively.



Key Areas Where Labour Ward Fire Drills May Be Used




  • Umbilical cord prolapse, shoulder dystocia, obstetric haemorrhage, eclampsia and undiagnosed vaginal breech



  • Sudden postpartum maternal collapse, operative vaginal births and unexpected poor neonatal outcome



Key Implications




  • Fire drills were initially advocated in the 1999 ‘Confidential Enquiry into Maternal Deaths’, which reiterated and emphasised the use of high-fidelity simulation training in maternity care [1].



  • The most recent centre for maternal and child health enquiries (CEMACE report, 2006–2008) reiterated and emphasised the use of high-fidelity simulation training in maternity care [1].



  • The use of simulation training in other medical fields has been shown to lead to improved performance. Studies exploring the use of simulation as a training tool within obstetrics have been encouraging. Improved clinical outcome has been demonstrated where simulation training was used in the management of shoulder dystocia [2].



  • ‘Fire drills’ provide a relaxed stress-free environment in which trainees and clinicians can learn and develop hands-on skills.



  • Regular fire drills and simulation training can also be applied as a means of improving patient safety aimed at reducing medical errors and adverse events.



Key Pointers to Setting Up Labour Ward Fire Drills



Planning




  • Get the required equipment for the ‘planned simulation’ of the given obstetric emergency (e.g. manikin, postpartum haemorrhage [PPH] trolley) (Figures 42.142.4).



  • Identify a suitable location within the labour ward (e.g. a vacant delivery room).



  • Develop a structured process for each obstetric emergency and clearly define roles for all team members involved in the fire drill.



  • Assigned roles include that for the anaesthetist, obstetrician, senior midwife, junior midwife, healthcare assistant and midwifery and medical students.



  • Prior to commencing the fire drill, inform labour ward matron to ensure maximum participation of clinicians.



  • Ensure that the fire drill is conducted at a time when there is no ongoing obstetric emergency in the labour ward to maximise participation and learning.





Figure 42.1 Postpartum haemorrhage (to estimate blood loss and to initiate appropriate actions).





Figure 42.2 Assisted vaginal breech delivery (if inferior angle does not become visible – the need to initiate Lovset’s manoeuvre).





Figure 42.3 Cord prolapse in second stage of labour – emergency ventouse delivery.


May 9, 2021 | Posted by in OBSTETRICS | Comments Off on Chapter 42 – Setting Up and Running Labour Ward Fire Drills
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