Improvement Story Six
MDT simulation for improving team performance in optimal cord management
Lancashire Women and Newborn Centre, Burnley General Hospital, East Lancashire NHS Trust
Contributor: Dr Jasim Shihab (Consultant Neonatologist and Neonatal Simulation lead)
Acknowledgement: The neonatal simulation team, Lancashire Women and Newborn Centre
What aspects of culture did you focus on and what changes did you make?
Simulation has been a driving force in implementing guidelines and as well as sustaining continued training and improving team performance in Lancashire Woman and Newborn Centre. In relation to Perinatal Optimisation we used simulation to implement optimal cord management using the Lifestart guideline. Once the implementation of Lifestart was done, a simulation team which included consultants, senior and junior trainees, nursing educators and nursing staff was created to implement regular simulations. Weekly multidisciplinary simulations were introduced with facilitators as well as participants being rostered in. These realistic simulations involved obstetric, neonatal, anaesthetic and theatre staff. Practical issues were identified and corrected using feedback from sessions. The guideline was also tweaked based on feedback. 85 % of staff were trained over 4 months.
When COVID hit we used in situ simulation and incorporated a mix of simulation practices which included rapid cycle deliberate practice to implement the COVID guidelines and this was successful in improving staff performance as well as reducing staff anxiety.
One of the key decisions taken in 2021 was that a robust 6 monthly simulation programme will help with ongoing training. Monthly theme based sessions have been incorporated on a 6 monthly basis which coincides with the neonatal trainee rotation. The first month are task training procedural as well as equipment sessions which includes use of Lifestart and servocontrol in preterm resus. This is followed by monthly sessions on preterm stabilisation, term with no cardiac output, DOPE, the collapsing neonate and the last month having miscellaneous sessions. All scenarios have been prewritten and faculty are aware of equipment, and scenario required for each sim sessions.
What effect this has had on your team culture?
Engaging staff in small sessions and then opening it up large multidisciplinary sessions helped sway staff to become simulation enthusiasts.
What barriers have you had to overcome?
An initial culture of fear of simulation from both medical and nursing staff.
There have been barriers as regular sessions can be run only with staff who are on the clinical floor. Facilitator availability was also initially a problem. Setting a fixed time on specific days of the week after discussion with senior nursing staff and medical staff alleviated this problem though we still have some sessions being missed due to unit acuity.
What helped to make this successful?
All of the above has only been possible with the continual hard work of the neonatal sim team as well as the consultant and nursing facilitators and having wonderful staff willing to incorporate positive change and thus improve overall team performance.