TY - JOUR
T1 - Strategies to Improve Management of Shoulder Dystocia Under the AHRQ Safety Program for Perinatal Care
AU - McArdle, Jill
AU - Sorensen, Asta
AU - Fowler, Christina I.
AU - Sommerness, Samantha
AU - Burson, Katrina
AU - Kahwati, Leila
N1 - Publisher Copyright:
© 2018 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
PY - 2018/3
Y1 - 2018/3
N2 - Objective: To assess implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. Design: Mixed-methods implementation evaluation. Setting/Local Problem: Labor and delivery units (N = 18) in 10 states participating in the Safety Program for Perinatal Care (SPPC). Shoulder dystocia is unpredictable, requiring rapid and coordinated action. Participants: Key informants were labor and delivery unit staff who implemented SPPC safety strategies. Intervention/Measurements: The SPPC was implemented by using the TeamSTEPPS teamwork and communication framework and tools, applying safety science principles (standardization, independent checks, and learn from defects) to shoulder dystocia management, and establishing an in situ simulation program focused on shoulder dystocia to practice teamwork and communication skills. Unit staff received training, a toolkit, technical assistance, and unit-specific feedback reports. Quantitative data on unit-reported process improvement measures and qualitative data from staff interviews were used to understand changes in use of safety principles, teamwork/communication, and in situ simulation. Results: Use of shoulder dystocia safety strategies improved on the units. Differences between baseline and follow-up (10 months) were as follows: in situ simulation (50% vs. 89%), teamwork and communication (67% vs. 94%), standardization (67% to 94%), learning from defects (67% vs. 89%), and independent checks (56% vs. 78%). Interview data showed reasons to address management of shoulder dystocia, various approaches to implement safety practices, and facilitators and barriers to implementation. Conclusion: Successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The SPPC strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.
AB - Objective: To assess implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. Design: Mixed-methods implementation evaluation. Setting/Local Problem: Labor and delivery units (N = 18) in 10 states participating in the Safety Program for Perinatal Care (SPPC). Shoulder dystocia is unpredictable, requiring rapid and coordinated action. Participants: Key informants were labor and delivery unit staff who implemented SPPC safety strategies. Intervention/Measurements: The SPPC was implemented by using the TeamSTEPPS teamwork and communication framework and tools, applying safety science principles (standardization, independent checks, and learn from defects) to shoulder dystocia management, and establishing an in situ simulation program focused on shoulder dystocia to practice teamwork and communication skills. Unit staff received training, a toolkit, technical assistance, and unit-specific feedback reports. Quantitative data on unit-reported process improvement measures and qualitative data from staff interviews were used to understand changes in use of safety principles, teamwork/communication, and in situ simulation. Results: Use of shoulder dystocia safety strategies improved on the units. Differences between baseline and follow-up (10 months) were as follows: in situ simulation (50% vs. 89%), teamwork and communication (67% vs. 94%), standardization (67% to 94%), learning from defects (67% vs. 89%), and independent checks (56% vs. 78%). Interview data showed reasons to address management of shoulder dystocia, various approaches to implement safety practices, and facilitators and barriers to implementation. Conclusion: Successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The SPPC strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.
KW - labor and delivery
KW - patient safety
KW - perinatal care
KW - quality improvement
KW - shoulder dystocia
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U2 - 10.1016/j.jogn.2017.11.014
DO - 10.1016/j.jogn.2017.11.014
M3 - Article
C2 - 29304317
AN - SCOPUS:85042906767
SN - 0884-2175
VL - 47
SP - 191
EP - 201
JO - JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
JF - JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
IS - 2
ER -