key: cord-1006443-6vcancid
authors: Moxon, H.; Turner, K.; Sawyerr, A.; Hamilton, K.
title: P.76 Introduction of an obstetric simulation programme to meet training needs during the COVID-19 pandemic
date: 2021-06-09
journal: Int J Obstet Anesth
DOI: 10.1016/j.ijoa.2021.103074
sha: b3c023d4eac47de021538b2ebf7c565aedbe6a6d
doc_id: 1006443
cord_uid: 6vcancid

nan

PDSA 1: August 2018: Staff education of the pathway, assessment of power and sensation incorporated into routine postoperative monitoring, dedicated ELCS midwife appointed, changes made to the admission location and a patient information leaflet produced. PDSA 2: June 2020: Changes made to the timing of ELCS lists, with all lists starting in the morning. PDSA 3: November 2020: Women allowed to drink water freely up until being called to theatre.

Results: Following the three PDSA cycles, preoperatively the median fasting time for clear fluids decreased from 6.5 h to 0.8 h. Postoperatively, the median time for food decreased from 3.5 h to 2.5 h. The median time for catheter removal decreased from 19.5 h to 8.5 h and the median time for mobilisation decreased from 20 h to 8 h. However, some variability in times still exists for catheter removal and mobilisation, with longer times recorded if sections occurred in the afternoon. The average length of stay decreased from a baseline of 3 days to 2 days.

Discussion: With the introduction of the enhanced recovery pathway, we have demonstrated improved perioperative care and achieved over 50% improvement in preoperative fasting and postoperative catheter removal and mobilisation. Data collection is ongoing, with the aim to further standardise care, reduce length of stay and improve maternal experiences. Next steps include: second update to the patient information leaflet and a video of the elective pathway to increase mothers' expectations and decrease anxiety about the ELCS process. Extra interventions to be added include routine dexamethasone and mothers administering own simple analgesics to maximise postoperative analgesia. Introduction: Training and service delivery in hospitals across the UK has been profoundly impacted by the COVID-19 pandemic. Continuing multidisciplinary team (MDT) training has been shown to be highly beneficial, particularly in obstetric departments where large numbers of staff work together in high-stress situations. 1 Social distancing restrictions have made existing organised training programmes impossible to deliver effectively, therefore we established an in-situ simulation training programme.

Methods: We created a multidisciplinary faculty of anaesthetic, obstetric, midwifery, theatre and neonatal staff to develop and facilitate the sessions. We identified learning needs from three main categories: mandatory training that could not be delivered, recent clinical incidents and new processes such as donning and doffing PPE and transferring COVID patients. We then created suitable scenarios from an evidencebased framework, 2 and stored them in a local database. Simulation sessions used a combination of high and low fidelity mannequins, and participants were the clinical teams working that day. Feedback was collected for each session, and learning themes were shared widely using a weekly updated 'learning board'. Social distancing and PPE guidelines were followed to maintain staff safety.

Results: Between March and December 2020, 214 staff members from labour ward and neonatal MDT have participated across 20 simulations. Two further simulation sessions took place on the antenatal unit and midwifery-led birth centre. From the feedback collected, >90% of participants found the simulation sessions useful or very useful. >50% of participants reported that their confidence in managing the respective clinical scenario had improved, with a mean increase of 26% of scores on a visual analogue scale. The majority of participants thought that the sessions were well-run and that their confidence has improved in managing the respective clinical scenario.

Discussion: We have delivered a flexible programme that addresses many of the learning needs that have become impossible to achieve during the COVID-19 pandemic. The proven benefits of MDT simulation training 3 have extended beyond individuals' learning needs, and we have been able to develop COVID guidelines by simulating processes and acting on staff feedback. Future simulation sessions are planned to include remote areas to labour ward including the emergency department, antenatal clinic and general theatres.

Enhanced recovery after elective caesarean: a rapid review of clinical protocols, and an umbrella review of systematic reviews

The effectiveness of training in emergency obstetric care: a systematic literature review

Obstetric Decision-Making and Simulation

Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review

Introduction: Skin-to-skin care (SSC) is defined as "contact immediately after birth holding the naked baby against mother's skin, between the breasts, lasting for as long as the mother wishes." 1 NICE and WHO state that SSC should be immediate and without delay unless there is a medically justifiable reason. 2,3 Maternal benefits include improved physiology, bonding and confidence handling their infant and less postpartum haemorrhage and depression. 4,5 Benefits to the infant include improved breast feeding and physiological stability, e.g. improved oxygenation, blood glucose control, thermoregulation and reduced stress hormones and crying. 4 Practice of SSC during caesarean section is variable, especially during emergencies. The project aims were to determine the prevalence of SSC in theatre and to establish barriers.Methods: Women who underwent caesarean section were surveyed post-delivery on their experience of SSC in theatre in 2 obstetric units in the same trust. This was repeated after raising staff awareness of SSC.Results: 73 patients were surveyed in the initial audit and 112 patients in the re-audit. Mean patient satisfaction scores were 9.76/10 in those who had SSC in theatre and 9.03/10 in those who did not have SSC (P = 0.026).

International Journal of Obstetric Anesthesia 46 (2021) 102988