Rapid Response for Perinatal Safety: Slide Presentation
Slide 1: AHRQ Safety Program for Perinatal Care
Rapid Response for Perinatal Safety
Slide 2: Learning Objectives
Image: Three ascending steps show the learning objectives:
- Define components of a rapid response system.
- Identify the key safety elements of a robust rapid response system.
- Identify tways to apply key safety elements to your unit procedures for rapid response to urgent maternity care.
Slide 3: Rapid Response
- Rapid response for maternal and fetal physiologic deterioration and urgent conditions is the focus of this bundle of the AHRQ Safety Program for Perinatal Care (SPPC).
- The training materials and tools in this bundle review the key elements of a rapid response system within the framework of the Comprehensive Unit-based Safety Program (CUSP).
- The key safety elements provide a comprehensive starting point for each unit to consider as it establishes its processes for ensuring rapid response capabilities.
Slide 4: Rapid Response System
A rapid response system (RRS) includes four components:1,2
- A mechanism for activating a clinical team response based on patient criteria.
- A multidisciplinary clinical team that can rapidly respond to assess and intervene in order to prevent further deterioration.
- A system for feedback, to help mitigate or improve response to similar situations in the future.
- An administrative structure to implement, train, and monitor all related activities.
Slide 5: Obstetrical RRS
- Distinct from a medical RRS or emergency "code" team.
- Distinct from neonatal RRS.
- Although distinct, close coordination is critical.
Slide 6: Evidence for RRS
- Some evidence supports the use of RRS for improving patient safety and outcomes, mainly for improving cardiac care.1,2
- Most studies of RRS in the literature are from unblinded, nonrandomized studies conducted at single centers.
- Support for implementing RRS is based on the principle that early intervention can improve patient outcomes.3
- Numerous hospitals are implementing RRS, many through participation in the Institute for Healthcare Improvement’s 5 Million Lives Campaign.
- Studies and experience with the use of RRS for maternity patients are emerging.4,5,6,7
Slide 7: RRS Tool
- Who Should Use.
- How To Use.
- Key Safety Elements.
- Supporting Materials:
- RRS Planning Worksheet.
- Sample RRS call log.
Slide 8: SPPC Key Perinatal Safety Elements for RRS
- Standardize When Possible (CUSP Science of Safety).
- Create Independent Checks (CUSP Science of Safety).
- Learn From Defects (CUSP Module).
- Simulation (SPPC Pillar).
- Teamwork Training (TeamSTEPPS®).
- Patient and Family Engagement (CUSP).
Slide 9: Key Safety Elements: Standardize When Possible
- Establish a unitwide approach for a rapid response to urgent maternity care issues.
- System is established as part of a hospital’s larger rapid response system, or is established as a separate entity.
- Uniform mechanism for activating a rapid response.
- Uniform approach to responding to an activation:
- Staff and equipment.
- Scope of response.
- Documentation requirements.
- System feedback.
Slide 10: Key Safety Elements: Standardize When Possible
- Develop standard criteria for activation of a rapid response:
- General activation criteria.
- Specific activation criteria.
- Coordination with hospital medical emergency or "code" teams:
- Specific activation criteria for nonmaternity care urgencies or emergencies (e.g., cardiopulmonary issues or arrest).
Slide 11: Key Safety Elements: Standardize When Possible
- Establishment of a standard rapid response kit or cart for the most common situations for which a rapid response is likely to be activated:
- Cognitive aids (e.g., checklists, protocols, algorithms, dosing guides, electronic fetal monitoring nomenclature).
- Standard location.
- Process for checking kit/cart and restocking.
Slide 12: Key Safety Elements: Create Independent Checks
- Use a team of multidisciplinary staff for responding to rapid response activations.
- Multidisciplinary responders offer built-in redundancy and another "set of eyes" on the situation.
- Rapid responders should—
- Possess specialized maternity care clinical skills, knowledge, and equipment.
- Be able to assess and manage a maternity patient who has deteriorated physiologically.
- Be able to intervene to minimize risk of serious harm and further deterioration.
Slide 13: Key Safety Elements: Create Independent Checks
- Different models for the multidisciplinary team of responders exist and can vary by the following:
- Volume and complexity of maternity patients cared for.
- Availability of in-house obstetric hospitalists (also called laborists) and dedicated anesthesiology support of labor and delivery (L&D).
- Presence of graduate medical education or nurse midwifery programs with in-house residents or students.
- Other available hospital rapid response teams.
- Core rapid response staff typically includes a maternity care provider (obstetrician or midwife) and a staff L&D nurse.
- Other responders may include an anesthesiology provider, an L&D or operating room technician, additional L&D staff nurses, or surgeon.
- Units establish the scope and limits of rapid responders.
Slide 14: Key Safety Elements: Learn From Defects
- Debrief and analyze near misses and adverse events, regardless of whether a rapid response was activated.
- Debrief among clinical team after rapid response, regardless of outcome.
- Have informal debriefs among clinical team.
- Rapid Response Call Log can facilitate a debrief.
- Have a process in place to review serious maternal or neonatal adverse outcomes.
- Share outcomes or process improvements from informal and formal analysis with staff to achieve transparency and organizational learning.
Slide 15: Key Safety Elements: Simulation
- Use of simulation to practice and train teams on rapid response processes.
- Simulation can reinforce teamwork and communication related to—
- Situational awareness.
- Ability to get additional help quickly and activate a rapid response based on unit-established criteria and processes for activation.
- Communication between primary care team and rapid responders.
- Communication with patient/family.
- Use of briefings, huddles, and debriefings.
Slide 16: Key Safety Elements: Teamwork Training
- Have situational awareness during rapid response events.
- Use SBAR, callouts, huddles, and closed-loop communication techniques during a rapid response.
- Communicate during transitions of care.
- Have high-reliability teams.
Slide 17: Key Safety Elements: Teamwork Training
- Characteristics of high-reliability teams:
- Anyone can sound an alarm, request help, or challenge the status quo.
- Hierarchy is minimized.
- Communication is continuous, valued and expected.
Slide 18: Key Safety Elements: Patient and Family Engagement
- Unit approach incorporates—
- Mechanisms for patient activation of a rapid response.
- Communication with patient/family during rapid response.
- Disclosure of any unintended outcomes.
Slide 19: Unit Next Steps
- Decide whether to select the rapid response system bundle for implementation locally. Consider these factors:
- Unit data suggesting adverse events or near misses that may have been minimized or averted as a result of a rapid response system.
- Synergy with related or similar initiatives, or existing hospital rapid response systems.
- Interest and enthusiasm of unit staff and administration for implementing.
Slide 20: Unit Next Steps
- Review the Key Safety Elements of the Rapid Response Tool, including the Planning Worksheet and Sample Call Log available as an appendix to the tool.
- Support implementation of unit rapid response system through:
- Staff training/communication.
- Monitor implementation progress, collect data for quality improvement.
Slide 21: Tips for Implementation Success
- Use CUSP principles for implementing teamwork and communication (e.g., incorporating diverse perspectives) to develop consensus on activation criteria and response expectations.
- Provide education and training to staff on the use of the RRS and make routine education for patients and family on the rapid response activation a part of the admission process.
- Debrief regularly after rapid response events, and solicit ongoing feedback from staff and patients to continually refine RRS processes.
- Devita MA, Bellomo R, Hillman K, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med 2006 Sep;34(9):2463-78. PMID: 16878033.
- Jones DA, DeVita MA, Bellomo R. Rapid-response teams. N Engl J Med 2011 Jul 14;365(2):139-46. PMID: 21751906.
- Preparing for clinical emergencies in obstetrics and gynecology. Committee Opinion No. 590. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:722–5.
- Skupski DW, Lowenwirt IP, Weinbaum FI, et al. Improving hospital systems for the care of women with major obstetric hemorrhage. Obstet Gynecol 2006 May;107(5):977-83. PMID: 16648399.
- Gosman GG, Baldisseri MR, Stein KL, et al. Introduction of an obstetric-specific medical emergency team for obstetric crises: implementation and experience. Am J Obstet Gynecol 2008 Apr;198(4):367.e1-7. Epub 2007 Nov 5. PMID: 17981251.
- Srinivas SK, Lorch SA. The laborist model of obstetric care: we need more evidence. Am J Obstet Gynecol 2012 Jul;207(1):30-5. doi: 10.1016/j.ajog.2011.10.009. Epub 2011 Oct 15. PMID: 22138138.
- Catanzarite V, Almyryde K, Bombard A. Ob team stat: developing a better L&D rapid response team. Contemp Ob/Gyn 2007;52(9):52-65.
Slide 23: Disclaimer
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