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