Shoulder Dystocia Drills

NPinWCH · Sep 18, 2011

I worked OB in a rural hospital with the same staffing you mention for 15 years. We did drills. It was part of our yearly re-orientation/safety training. It's like any other mock code and we used the hospital's old full body dummy as our patient. Someone is the moderator who explains what is going on and then you role play the rest.

We did have an emergency kit for hemorrhage. It had IM methergine, Hemabate and cytotec, plus pitocin in it along with syringes and 2 liters of IV fluid, IV start kits and other assorted items. It was kept in a locked box that could be grabbed if you needed it.

Elvish, BSN, DNP, RN, NP · Sep 19, 2011

We also do shoulder dystocia drills like the one mentioned in the previous post.

Our pp hemorrhage kit also has IV start kits, angiocaths, IM injection stuff, and shoulder-length gloves for manual extractions. We don't keep meds/fluids in our kit but grab them out of the Pyxis in case of a pph and we anticipate we'll need them. (Our standing pp orders allow us to put up to 40u of pit in a liter of whatever fluid the pt has running if the bleeding is heavy. Sometimes that's a good thing and sometimes not, esp if she has had a long augmented labor and her uterus is tired/unresponsive to pit.)

FLOBRN · Sep 19, 2011

these kind of drills are becoming more and more popular. It helps everyone automatically know what their role is and lowers the tension when the actual situation is encountered.

If you join the Perinatal Nursing list you will be connected with professionals across the country who have an unlimited depth of information. Everyone is always more that willing to share policies, information etc. It could help your case a lot. Good Luck.

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luv4nursing · Sep 19, 2011

Is there any way you can point me to the article? This sounds like a great idea for the unit I just started training on. Staffing is scarce and there are a lot of new grads and new to OB nurses and few experienced nurses left at the moment. This would be a great tool so us newbies can feel a little more comortable the first time we face these situations.

feisty · Sep 19, 2011

The article was in the December 2008/ January 2009 edition of "Nursing for Women's Health." It is entitled "Shoulder Dystocia Drills: How One Unit Prepares for Potential Obstetric Emergencies" by Kathleen Curtis, RN, MS and Lola Guillien, RNC.

The article provides an algorithm to determine the responsibility of each participant. It is designed for use in a large facility, but it could be modified to meet the needs a much smaller hospital. It also gives an acronym for the steps to follow during a dystocia event.

HurricaneCasRN · Sep 19, 2011

I think that is a FABULOUS idea. I had my daughter at a large hospital about 30 miles outside of Chicago. I'm told that she was head out with a dystocia for eight minutes. EIGHT! (Even I find it hard to believe) Rules changed after she was born, for instance not only are staff RNs that are family no longer brow beaten in to taking the case because "we're busy and you'll be here anyhow" they aren't allowed to deliver family at all. (my sister was my nurse. She called the Code) I'd love for all L&D floors to be totally up to date and practiced. My OB was on vacation, the OB on call for her was pretty new (no hate from me, we're all new sometime. I'm new now) My sister went to a c section and asked the senior doc on the floor to break scrub and get in there. At first she refused. She was suturing. When my sister told the doc it was HER sister, she came immediately. The next day, I asked the doc how she finally got her out, all the maneuvers had been tried, I think they even tried to "cork screw" my daughter back in so a section could be done. The doctor told me "I prayed and told you to push one more time." My daughter is QUITE well now, she had a brachial plexus injury, an APGAR of 2 and some lingering lethargy from the delivery. A few days in NICU and we finally got her eating on her own. But, she's perfectly healthy now (still INCREDIBLY stubborn). I think the staff and patients would all feel at least a little better if there were a consistent algorithm. I could be wrong in my memory, but it seemed like everyone just did what they thought of. No one doing anything incorrectly or dangerously. But, not a smooth code. Not a HORRIBLE one, my daughter is alive, but not clockwork either. I bet they'd feel a little of the edge off if their was a practice and each person had Role A, B, C and D when they came in the room instead of all hands on deck. (and it really was all hands on deck. I've never seen a room fill so fast after the code was called.)

feisty · Sep 19, 2011

Hurricane, that is a scary situation. Glad your daughter is healthy.

FLOBRN, thanks for the link. I believe it will be a wonderful asset to have.

Thanks to everyone for the responses and info on PPH kits.

stustressed · Oct 4, 2011

I have worked in two different OB units. In one unit we had a manequin that simulated a dystocia and we were all required (even physicians) to attend the drill. The other hospital we (2-3 RNs at a time) went into a room with an educator and "walked" through what a dystocia would look like, what we would do etc. We also filled out quizzes at both facilities. In one of the hospitals we had a dystocia time sheet printed and taped to the inside of the closet so someone could be the timekeeper and keep track of what happened when for charting purposes. It also was helpful b/c they would call out to the RN (s) and the doc..30 sec, 1 min, etc. Time always seems longer when it is a stressful situation.