WHY ALSO® - Advanced Life Support in Obstetrics?
AAFP presents the ALSO program in a blended classroom environment, to include both on-line and "live" classroom in situ drills/workstations. Participants will be required to take both a pre and post-test prior to classroom attendance. Didactic material will be available approximately 30 days from scheduled class date for review and participants must email letter of completion to course instructor prior to class date or they will not be permitted in class. Cost for online material is $120.00 per attendee payable by the hospital/attendee and is not included in instructor cost. CEUs/CME’s provided by AAFP. (see website for details)
ALSO involves utilizing a standardized approach to intense emergency obstetrical situations/drills. Knowledge of content, practice of skills, and use of mnemonics will allow learner to quickly retrieve “actions” necessary to reduce morbidity. AAFP list safety statistics as poorly managed births causing 289,000 mortalities worldwide and medical errors being the third leading cause of death in the United States, costing $8 to $29 billion annually. Patient outcomes are shown to improve when team members work together in an environment where practicing team training is considered a high priority. Heavy emphasis is placed on communication during the workstations and skill check-offs as The Joint Commission (TJC) list communication failures as a root cause of over 50-70% of maternal and perinatal sentinel events. Teamwork tools such as situational awareness, standardized language, closed-loop communication and shared mental model will be emphasized during workstations and skill check-off using in-situ drill sets.
AAFP (ALSO®) list learning objections as ability to:
- Discuss methods of managing pregnancy and birth urgencies and emergencies, which standardizes the skills of practicing maternity care providers.
- Demonstrate content and skill acquisition as evidenced by successful completion of course examination, skills workstations, and group or mega delivery testing stations.
Learner will gain competency and confidence in effective teamwork skills in the management of maternal & neonatal emergencies such as:
Shoulder dystocia, labor dystocia, assisted vaginal delivery, malpresentations/malpositions, third trimester bleeding, postpartum hemorrhage, emergency vaginal breech, eclampsia, cord prolapse, amniotic fluid embolus, maternal resuscitation and perimortem cesarean section.
Learner will review the intense didactic material on-line prior to the ALSO skill/workstation class (approximately 8 hours). This blended classroom presentation allows the learner to review the material at their own pace and is available to be reviewed for approximately 1 year from purchase date. Early recognition is the key to limiting morbidity and mortality in these high-risk events, learner will be more prepared to recognize and intervene timely.
Each emergency will have in situ drills for unit awareness, equipment location and availability that is needed quickly in the various emergency situations as well as review of appropriate hospital policies for management of care such as massive blood transfusion protocol, blood administration, code cart awareness/supplies. Available products such as the balloon tamponade Floseal will be reviewed for quick retrieval in Postpartum Hemorrhage and proper assembly/nursing care management.
Learner will be able to describe the potential maternal, fetal and neonatal complications of the critical events listed above as well as the nursing and clinical skills for proper interventions, charting and assessment of outcomes.
Learner will be able to incorporate “at risk” data for the antepartum and intrapartum period for these unanticipated high morbidity, low frequency events listed above.
Learner will focus on self-leadership skills in emergency situations and become more aware of strengths and weaknesses such as use of closed-loop communication and situational monitoring. Mutual support and communication will be enhanced at course conclusion.
Pre-test and post-test assessment is objectively calculated through a standard test prior to class drill attendance.
Learner will practice and incorporate team brief, huddle and debrief after critical events and utilize to improve team function as the “what went well” and “what could have been done better” format. After all, the only way we will get better for the future is by identifying system issues and improving medical and nursing management.
In-situ drills ideally will be led by MD/DO from L&D and will allow for multidisciplinary and inter-professional teams to practice managing emergencies. (THIS IS THE PLAN)
One of the biggest advantages to this is to provide intense obstetrical high-risk drills, as no formal training has ever been provided in my 25 years of labor and delivery experience.
I wanted to list a few of the mnemonics to be used during training such as:
4Ts of postpartum hemorrhage: per AAFP (ALSO®) used with permission
- Tone: ATONY and correct drugs and dosages
- Trauma: Lacerations
- Tissue: Retained placental fragments
- Thrombin: Clotting issue of client (HELLP, DIC)
We will also review and explore a new nursing action of Quantification of Blood Loss (QBL) which is proven to be a key action in early recognition of PPH. Learner will be given the opportunity to “estimate” blood loss and realize that blood loss is often under estimated leading to late recognition of PPH and subsequent sequela.
Shoulder Dystocia mnemonic per AAFP (ALSO®) - used with permission
The HELPERR Mnemonic:
H - Call for HELP
E - Episiotomy (Consider)
L - Legs- McRoberts
P - Pubic- Pressure (suprapubic and proper direction to apply to deliver anterior shoulder)
E - Enter Maneuvers- per MD (Rubin, Rubin II)
R - Removal of posterior arm
R - Rotate maternal position (Gaskin) could lead to Zavanelli
In conclusion, ALSO will help clinical staff evaluate and improve responses to obstetric emergencies. Procedures to improve facility quality for emergency preparedness will be enhanced by having these intense in-situ drill scenarios and will be a “win-win” for both the patient and the hospital team system. Luckily, devastating obstetric emergencies are rare. Without a way for clinicians to maintain knowledge and skills in managing obstetric emergencies, pregnant women are at risk of not receiving the care they need when they face life-threatening complications. Stepping outside of the classroom, obstetric emergency drills—simulations of managing a woman with the most common obstetric emergencies—allow nurses, physicians and support staff to gain and maintain knowledge, build skills and teamwork, and improve communication to safely manage these complications. ALSO provides obstetrical emergency drill sets to allow providers to practice applying their skills to these infrequent, but deadly, events in the same setting as they would manage a real emergency. Completing drill sets such as Postpartum Hemorrhage, Prolapsed Cord, Shoulder Dystocia, AFE, and Maternal Resuscitation will improve patient safety and quality of care!
Documentation to your institutions for the attendees will be provided by Triple S Review Services, LLC.
PRICING: $1,950.00 per class of 6 attendees/plus travel (priced according to location) Pricing is per class not per attendee.
Hospital system must provide mannequin for resuscitation drills as well as unit specific equipment for emergencies/$120 AAFP fee in addition to Instructor cost.
At this point, my question now to you is….
- Quality Improvements
- Enhance Knowledge
- Current Standards of Care
- In-situ drill simulation
- Teamwork Competency
- Team Collaboration
- Enhance Skills
- High-Risk Drills
- Situational Monitoring
…………….And now you know “ALSO!”
Stephanie Swilley, MSNEd, RNC-OB