Check One, Check Two, Check Three. Implementation of a Shoulder Dystocia Checklist in the Labor and Delivery Unit

Abstract

Purpose for the Program Shoulder dystocia is an obstetric emergency that requires teamwork, effective communication, and collaborative documentation. The labor and delivery (L&D) unit is an area of high liability. The shoulder dystocia checklist was designed to assist staff with management and documentation and, thus, improve patient safety. Proposed Change To implement a shoulder dystocia checklist to improve standardized management and collaborative documentation and, thereby, improve maternal and neonatal outcomes. Implementation, Outcomes, and Evaluation The nurse manager, clinical educator, and a physician champion developed a checklist. It was introduced to the L&D nurses during designated days of education so that they would have the opportunity to test the process. Staff provided feedback and the checklist was revised according to their suggestions. The checklist was placed in every L&D room in a specific location next to the infant warmer. During a shoulder dystocia, staff called for help and the checklist was immediately implemented to provide a standardized approach to management and collaborative documentation. The checklist was used as a worksheet and was not a permanent part of the medical record. Postdelivery, the team (i.e., L&D registered nurse [RN], obstetrician, certified nurse–midwife, and neonatal intensive care unit RN) used the checklist to collaboratively document staff arrival times, maneuvers, and patient response to maneuvers. The checklist was trialed with positive feedback. The nurses had a vested interest because they assisted with the revisions. The checklist has been adopted system wide. The medical record shows improved adherence to standardized management and documentation consistency during shoulder dystocia emergencies. In addition, nurses have reported increased confidence with their roles and responsibilities during this critical event. Implications for Nursing Practice Risk factors for shoulder dystocia may be present, but shoulder dystocia cannot be predicted or prevented. Therefore, it is imperative that shoulder dystocia training and simulation drills be a focus of ongoing education in the L&D unit. The shoulder dystocia checklist is a valuable tool used to guide management and collaborative documentation during this emergency situation. Shoulder dystocia is an obstetric emergency that requires teamwork, effective communication, and collaborative documentation. The labor and delivery (L&D) unit is an area of high liability. The shoulder dystocia checklist was designed to assist staff with management and documentation and, thus, improve patient safety. To implement a shoulder dystocia checklist to improve standardized management and collaborative documentation and, thereby, improve maternal and neonatal outcomes. The nurse manager, clinical educator, and a physician champion developed a checklist. It was introduced to the L&D nurses during designated days of education so that they would have the opportunity to test the process. Staff provided feedback and the checklist was revised according to their suggestions. The checklist was placed in every L&D room in a specific location next to the infant warmer. During a shoulder dystocia, staff called for help and the checklist was immediately implemented to provide a standardized approach to management and collaborative documentation. The checklist was used as a worksheet and was not a permanent part of the medical record. Postdelivery, the team (i.e., L&D registered nurse [RN], obstetrician, certified nurse–midwife, and neonatal intensive care unit RN) used the checklist to collaboratively document staff arrival times, maneuvers, and patient response to maneuvers. The checklist was trialed with positive feedback. The nurses had a vested interest because they assisted with the revisions. The checklist has been adopted system wide. The medical record shows improved adherence to standardized management and documentation consistency during shoulder dystocia emergencies. In addition, nurses have reported increased confidence with their roles and responsibilities during this critical event. Risk factors for shoulder dystocia may be present, but shoulder dystocia cannot be predicted or prevented. Therefore, it is imperative that shoulder dystocia training and simulation drills be a focus of ongoing education in the L&D unit. The shoulder dystocia checklist is a valuable tool used to guide management and collaborative documentation during this emergency situation.