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O1 Improved patient safety in obstetrics: reducing labour and complications. A success story using human factors and simulation training
  1. Ayshini Samarasinghe,
  2. Manjula Samyraju,
  3. Gill Harrison
  1. North West Anglia NHS Foundation Trust, Peterborough, UK

Abstract

Introduction Human Factors training helps to build a safe working environment and optimise performance by analysing how we perform as a multi-disciplinary unit. There has been increasing interest in the application of human factors within health care after the publication of Francis, Berwick and Each baby count reports. Human error and workplace cultures have been highlighted as one of the main contributory factors in adverse events and near misses in obstetrics. The use of simulation training using SIM-MOM training has been shown to be and effective method in encouraging active learning, team work and tailored to diverse learning styles. In this study, we employed Human Factor and SIM-mom training to reduce the risks of post-delivery bleeding and improve patient outcome following childbirth.

Aim We aim to create a tailored HF training programme and SIM-mom training for all staff to reduce the rates of bleeding, admission to critical care and blood transfusion post child birth. We developed and implemented a high-fidelity simulation learning package to be used by all team members involved in the care of the labouring women.

Study design This project involved getting ‘buy-in’ from the whole multidisciplinary team including obstetricians, anaesthetists, midwives, theatre practitioners and trainees. A baseline survey of perceived problems and PPH rates were carried out. The intervention involved a day of formal training for staff and the identification of ‘champions’ in each clinical area to ensure support for staff.

We developed and implemented a high-fidelity simulation learning package to be used by all team members involved in the care of the labouring women.

The outcomes were then measured through a repeated survey of attitudes and audit of PPH rates. The project was highly successful in reducing clinical risks, improved collaborative team-working and staff satisfaction.

Results The average rate of PPH declined from 9.2% in 2012–2013 to 5.6 in 2016–2017. In a unit that has an average delivery rate of 5050 per year that’s an average of 106 women saved from complications of PPH per year. The number of patients needing transfusion reduced from 378 to 254. Reduction in number of women needing admission HDU.

Conclusion This training has immensely helped to reduce a key maternity quality indicator, reduction of postpartum haemorrhage rate. To date, we are seeing that using Human Factors training and SIM-mom training improves behaviours leading to tremendous clinical benefit and cost saving.

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