obstetrical communication

Hello, my name is Joann Kawchuk. I spend my time in anesthesia, critical care and medical simulation. Communication and teamwork are the first steps to ensure patient safety in a team based approach to patient care. We hope to demonstrate both effective and ineffective styles of interaction in our video. Re-enactment of an obstetrical drama, Although primarily designed with obstetrical nurses in mind The principles discussed in this educational package have application in all aspects of acute patient care. I will guide discussion of clinical vignettes for individual learners watching this programme and give you an opportunity reflect on the meaning of interactions of the caregivers, both good and bad I recommend that you view the entire not-so-effective communication video, and then watch the debriefing section Topics touched on during the debriefing will be covered in greater detail in the commentary for the slide show. Links to individual topics from the debriefing will allow you to explore these topics in greater depth and then return to the debriefing In this clip note the effectiveness of the communication of the nurse with the charge nurse and the resident What’s up? I need some help, I’ve got a brady, ruptured membranes and some fresh bleeding. We’d better call the resident Hi, I was just paged Ah, VBAC, ruptured membranes some fresh bleeding, seven centimeters Is this the first time you’ve had any bleeding As far as I know The fetal heart rate looks like its improved I wonder why neither the nurse nor the resident recognized the severity of the fetal bradycardia And the seriousness of the maternal bleeding Joann, when you came in the room just then, and saw the strip, what was your impression of what was going on? When I got there, the fetal heart had recovered to one hundred, and the strip didn’t look that bad The nurse didn’t look too upset about what was going on, and the patient was really distressed with her contractions, and needed an anesthesia top up Anyway, I was really busy, I had two admissions waiting, and I knew they would call me it got worse You knew that the mom was bleeding and that the fetal heart was slow Why do you think Joann didn’t pick up on how worried you were. Joann is a really good resident, and I thought she knew what was going on If she thought that everything was all right just then, then maybe I was just over reacting Watch this clip to see how could Jan have improved her communication with the resident The fetal heart rate was down to sixty for at least two minutes before it recovered Yea, but I think it will settle down But Joann, I saw that fetal brady, and it was really slow to recover in the beginning Was there much bleeding? Don’t you think we should be calling Dr Sinclair? If anything changes, we’ll give her a call The heart rate is down to sixty again, and she’s hemorrhaging. I need help Call Dr. Sinclair to come now It’s just like last time Page Dr. Sinclair stat to Labour and Delivery Get the girls in the operating room to open for a possible stat section Term, VBAC, large amount of fresh bleeding, sustained bradycardia How long has she had these late decelerations, Dr. Sivertson? I just felt a gush She’s bleeding, I think she’s abrupting Call Anesthesia stat. Get me a consent form Your baby's in distress, we going to have to do a section Anesthesia stat, Labour and Delivery I know you don't want this, but this is best for you and your baby Get me a consent form! The resident realized she should have called the obstetrician sooner and felt responsible Joann, the patient seemed stable for a while, until Jan came out of the room saying that she started hemorrhaging with a fetal heart rate of sixty The obstetrician seemed angry and you looked confused, what were your thoughts just then? I’ve always been scarred of Dr Sinclair She really came down hard on me, I guess it was my fault for missing the late decelerations on the strip And I felt really bad I am just in second year, and I thought I was a good resident, but I really messed up when I didn’t call Dr Sinclair sooner It seemed very stressful for you to be called urgently to see a patient who was abrupting, You seemed to be very critical of the resident, what were you thinking just then? We should have done the section half an hour ago when the strip looked bad That baby was in trouble. Somebody should have let me know