Obstetric emergencies: training with skills drills

Chapter 24 Obstetric emergencies: training with skills drills




Local clinical governance, reinforced by various national structures, now underpins the functioning of the National Health Service (NHS). It requires the establishment of systems and ways of working that result in an improved standard of care for patients (Chief Medical Officer 2000).


Within obstetrics it is recognised that many untoward outcomes are unpredictable and unpreventable, but many reports have highlighted substandard care as being contributory to adverse outcomes (Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) (1999), Chief Medical Officer (2000) Confidential Enquiry into Maternal and Child Health (CEMACH) (2004)).


As a result litigation costs are high, as often is the human cost. Rarely is one factor alone responsible, and investigation of such incidents has now moved from a culture of blame to one of analysing systems that have contributed to the event, and seeking to establish measures that will help prevent a recurrence (Chief Medical Officer 2000).



The Clinical Negligence Scheme for Trusts (CNST) (2005) requires evidence of strategies in place to identify and minimise risk, and so hopefully reduce litigation.


This is driven by the notion that although many complications of childbirth are infrequently encountered, they have a propensity to be catastrophic. Prompt appropriate management endeavours to reduce serious morbidity and mortality.




TRAINING IN ACUTE OBSTETRIC EMERGENCIES




Fire drill


Various names have been given to these, e.g. skills drill, emergency drill, and fire drill. The term is imprecisely defined, and takes numerous formats. A survey of practice in 2003 assessed what format of drill individual units were undertaking, and how these drills were being organised and evaluated. The authors proposed the term ‘fire drill’ should imply the drill is conducted in the normal working environment (most commonly the labour ward) without prior knowledge of the staff involved (Anderson et al 2005). This has the following advantages:




A ‘fire drill’ has additional benefits to training from that undertaken in the classroom or at a site distant from one’s usual workplace and work colleagues.


At the time of the survey half of the responding units were conducting ‘fire drills’ as defined above. Many units were undertaking other forms of training in obstetric emergencies in addition to or in place of fire drills.


The positive aspects of fire drills as reported in the survey are:




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Mar 16, 2017 | Posted by in NURSING | Comments Off on Obstetric emergencies: training with skills drills

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