OB RAPID RESPONSE

TEAM
November 20, 2013 Meeting
Agenda
Goals and Measurements
How to Activate
Team Members
Roles
Expectations

Some Evidence
About 1-2% of
pregnancies are
complicated by an
obstetrical emergency
According to JCAHO, in
the majority of perinatal
death and injury cases,
the root causes are
related to problems with
organizational culture,
communication and
team work

Goals
1. Improve communication
in emergencies
2. Improve patient safety
3. Improve efficiency in
emergencies

Measurements
1. Measured by staff
perception with survey
2. Measured by staff
perception with survey
3. Measured in times
1. DecisionOR
2. ORBaby
3. Staff perceptions

Charting
Doc Flowsheets
Delivery times
Decision for C/S
time
Move to OR time
Delivery
Summary
C-Section
OR IN time is
charted as
Procedure Start
time
Brief/Debrief Form
Fill out if team called for case
Debrief sheet done by Charge RN or
Primary RN with team
Will be in Red Binders on top of Chart
racks on BC and WCC
Specified Obstetric Emergencies
Severe bradycardia
Hemorrhage
Eclampsia
Maternal Collapse
Shoulder dystocia
Cord prolapse
Any potential serious emergency in which a
team response is required

How to Activate
OB Rapid Response Team can be paged
by calling 84757
Operator will immediately pick up and take
your request
You will say I need the OB Rapid
Response Team to Room # This will send
out an immediate page to designated team
members

How to Activate
The OB Rapid
Response Team can
be activated by any
nurse, midwife or
physician team
member

You will need to
make a separate call
if you need the Peds
team
It is the same number
84757
In certain cases we
should be able to
page both at the
same time i.e.
shoulder dystocia


OBRRT is not taking away the Staff Assist

OBRRT
Patient or fetus declining
with failed interventions
Rapid team response
needed, include nursing,
anesthesia, techs and
attending MDs
Specified OB Emergency
Staff Assist
Extra nursing assistance
needed quickly
Patients stable with
interventions
The Staff Assist may be
used prior to activating
the OBRRT
Still important to crowd
control and communicate
effectively

Planning
February 2014
Go Live with our first OB
Rapid Response Team
Womens Care Center
and Birth Center
In future
Hope to expand team
response to outpatient clinics
ED or other floors where OB
patients reside

Team Members
OB Attendings
Anesthesia Resident and
CRNA
Scrub techs
Charge Nurses
Resource Nurses
Unless specified, team
members will respond to
their own floors

Resource/ 2
nd
RN
Labor Nurse on the labor side for the shift
Assigned by day or night shift Charge RN with Red Cross
Magnet on patient white board
Ideally is next labor (next admit) or has a patient that is
not 1:1 and at the bedside continuously
Notifies Charge RN when patient becomes 1:1 and
unable to leave the bedside to hand off pager
Good with receiving delegated tasks and responding
quickly and efficiently
When Charge RN and Primary RN are task saturated can
help where needed with good communication
Standardizing Emergency Roles
Above the
Waist RN
Below the
Waist RN
Resource/2
nd

RN
Often Charge RN- Team Leader
Assists patient above waist
Administers medications
Initiates Oxygen
Draws labs
Maintains IV line
Often Primary RN
Assists patient below the waist
Circulator in patient room
Gives report to appropriate
personnel
Charter/Recorder
Foley/Straight Cath
Assists Primary and Charge RN
Peds assist
Runner
Updates family
Helps with Charting
Crowd control
Emergency Roles in OR- Emergent C/S
Primary RN
Circulator
Timeout/Brief
FHTs
Surgical Counts
Brief Peds

Charge RN and
Resource/2
nd
RN

Place Foley
Prep Patient
Bovie Pad
Assist Anesthesia
Hand from Below

The Charge RN is the
Team Leader

Expectations
It is the expectation that each team member introduces
themselves, their roles, and uses Closed Loop
Communication
Speaks clearly
Uses names
Uses eye contact


Closed Loop
Communication
Example:

Sender:
Melissa, can
you get OR
meds?
Melissa: Yes I
am going to get
OR meds
Sender: Thanks,
Melissa
Receiver
accepts
message,
provides
feedback
confirmation
Sender
verifies
message
was
received
Sender
initiates
message
Expectations
Staff education and reinforcement
Charting
Assistance with correct activation
Noticing situations where the OBRRT would be beneficial and
communicating so
Staff Assist and OBRRT calls when not assigned to Resource
or Charge RN
Outside or nearby room
Run for supplies, meds, equipment
Take labs and specimens
Retrieve blood products
Stands by if needed for assistance
Already more educated as Primary RN
Crowd control


Expectations
Help with Simulation Drills
December and January
Starting with Emergent C/S using the OBRRT
Birth Center and WCC
Day and Night Shift

Help educate resistant staff
JCAHO recommends initiating rapid response teams in critical
areas to decrease adverse outcomes
This team is not being initiated because we are doing things badly,
there is always room for improvement with patient safety initiative
and communication on both floors
With previous miscommunications including a more recent case
where Anesthesia was not notified in an emergent case, our
Director, Julie Scott, insists we initiate a team that will wear pagers
and can respond in one call



Questions, Comments?

References
Clements, CJ, Flohr-Rincon, S., Bombard, AT, Catanzarite, V. OB
Team Stat- Rapid Response to Obstetrical Emergencies. Association
of Womens Health, Obstetric and Neonatal Nurses. (2007) 11(2)194-
199
Lipman, SS., Carvalho, B., Cohen, SE., Druzin, ML., Daniels, K.
Response times for emergency cesarean delivery: use of simulation
drills to assess and improve obstetric team performance. Journal of
Perinatology (2013) 33, 259-263