P2 Managing emergencies in obstetrics: simulation addressing the lessons to be learnt from maternal deaths

Abstract

Introduction Cardiac disease in pregnancy remains the leading cause of mortality and morbidly worldwide. Recognition and management can be challenging. In response to the MBRRACE Confidential Equiry into Maternal Deaths (Knight et al. 2016), we developed an interprofessional simulation-based training programme; 50% practical/technical skills and 50% human-factors skills. Summary of work A day long, high fidelity simulation course was designed and delivered on 6 occasions with plans to deliver it again. Each scenario involved a simulated-patient, played by the Maternal Simulator (Noelle®), an embedded practitioner and course participants (3–5) comprising of midwives, obstetricians, physicians and anaesthetists. Scenarios included acute coronary syndrome, pulmonary oedema, aortic dissection and cardiac arrest requiring peri-mortem C-section and were designed to meet a learning needs analysis associated with the outcomes of MBRRACE. Scenarios were followed by a debrief using the SaIL Diamond Debrief. The learning aims were Knowing and understanding the symptoms, signs and management of cardiac disease in pregnancy, utilising a systematic ABCDEF approach and develop human factor skill to improve patient. The impact of training was measured using a pre and post intervention assessment with a validated and reliable to tool for assessing interprofessional learning in human factor skills (Reedy et al. 2017) and participants knowledge of clinical management of cardiac disease in pregnancy. Results The intervention was delivered to 84 interprofessional healthcare professionals. There was an improvement in both participants’ knowledge, clinical management of cardiac disease in pregnancy and an improvement in a validated and reliable self-efficacy human-factors toolkit; I am confident in my knowledge of the physiological changes of the heart in pregnancy. The chi–square statistic was 15.4189. The p–value was I am confident in managing pregnant women with cardiac disease. The chi–square statistic was 15.4756. The p–value was Using the Human Factor Skills for Healthcare Instrument 0–10 score. The paired two–tailed T–test of 42 sets of paired pre and post data had a mean change 0.96. The value of t was 6.854051. The p–value was Discussion This interprofessional high fidelity course aimed to reduce mortality associated with cardiac morbidity. It addressed nationally identified learning needs in obstetric medicine. Through validated methodology, there is a demonstrable increased in human factor skills and technical knowledge and confidence in managing cardiac disease, whilst allowing for a greater understanding of others’ professional roles. Future work aims to demonstrate an enduring impact on practice. References Knight M, Nair M, Tuffnell D, Kenyon S, Shakespeare J, Brocklehurst P, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care – Surveillance of maternal deaths in the UK 2012–2014 and lessons learned to inform maternity care from the UK and Ireland Con dential Enquiries into Maternal Deaths and Morbidity 2009–2014 2016. Oxford: National Perinatal Epidemiology Unit, University of Oxford. Reedy GB, Lavelle M, Simpson T, Anderson J. Development of the human factors skills for healthcare instrument: A valid and reliable tool for assessing interprofessional learning across healthcare practice settings. BMJ Simulation and Technology Enhanced Learning 2017;3(4):135–41.