The Effectiveness of Training in Emergency Obstetric care Discussion

Abstract

Obstetric emergencies in the maternity unit are almost a norm and can happen at any time. Over decades, maternal morbidity has continued to rise in Sierra Leone from complications of childbirth, intra-and-post-partum. The major obstetric emergencies are postpartum hemorrhage, eclampsia, and sepsis. With Partners In Health – Maternal Centre of Excellence (MCOE) in Sierra Leone, we expect more women and more referrals and hence the potential of having more complicated cases. It is therefore important to have measures in place to curb the menace by being prepared all the time. The first steps would be to have the unit prepare themselves by assessing potential emergencies, establishing early warning systems; Identifying team leads who have the knowledge and capacity to lead during emergencies, emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. A successful emergency response team would benefit greatly from having appropriate emergency supplies in the emergency trolley/crash cart, protocols on handling emergencies, and having a rapid response team that will include,  constant implementation of drills and simulations. The Effectiveness of Training in Emergency Obstetric care Discussion

Keywords: Obstetric emergencies, maternity, labor and delivery, emergency preparedness, train

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Background

Many different types of obstetric emergencies can occur during labor. Obstetric emergencies can be very serious and can lead to both short- and long-term complications for the mother and baby.  In Sierra Leone, maternal mortality is a major health concern, with a ratio of 510 deaths per 100 000 live births, and is among the highest rates in the world (Carshon-Marsh et al., 2022). According to the study, hemorrhage was the major cause of maternal mortality, followed by eclampsia and  sepsis. Although our hospital has a competent nursing team and other care providers who can manage emergencies, morbidity and mortality from the emergencies are on the rise. It is unknown what continues to prevent full abatement of the poor outcomes. Thus, this capstone project seeks to intervene effectively to curb the development of obstetric emergencies and improve the outcomes of care in the labor and delivery room.

Impact Statement

The capstone project aims to provide emergency preparedness training focusing on the importance of being prepared in terms of manpower, supplies, and skills-wise. The expected outcome will be enhanced patient safety and the ability to mitigate adverse outcomes. The Effectiveness of Training in Emergency Obstetric care Discussion

Project Objective

The objective of this project is to implement obstetric emergency preparedness in the labor and delivery unit and improve overall patient safety. The project will ensure that a well-prepared team is available to recognize early warning signs and activate emergency protocols promptly. If a success, the  Maternity unit will adopt the project interventions at the antenatal and postnatal units.

PROJECT DESIGN AND IMPLEMENTATION

The goal of this phase is to ensure that all patients are safe since the care provider will be prepared for any emergency that may occur. During this phase, a  team of midwives and clinicians will help implement the plan. As the project manager, my roles will include overseeing the project,  ensuring the availability of the allocated resources, and ensuring all goals are met. Resources needed for the project include trained personnel, appropriate equipment,  constant supplies in the emergency trolley/crash cart, and protocols on handling emergencies. The project will involve the constant implementation of drills and simulations, and training for midwives.  According to Pattinson et al. (2019), implementing skills and drills on Emergency obstetric care (EmOC) training is significant in helping reduce maternal deaths. During this time, the team will use checklists and patient registers to investigate different ways to improve emergency preparedness. A focus will also be placed on ensuring that all stakeholders are aware of and involved in the project. The midwives will be responsible for implementing the emergency preparedness plan in the labor and delivery room. The team will train the midwives on how to be more prepared in case of an emergency by assessing potential emergencies and establishing early warning systems. As the project manager, I will help Identify team leads who have the knowledge and capacity to lead during emergencies, emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. Once the project is complete, it will provide a blueprint for future projects that aim to increase emergency preparedness in the labor and delivery room. The Effectiveness of Training in Emergency Obstetric care Discussion

Expected Results

By December 2022, we hope to see always stocked emergency trolleys, protocols on emergency preparedness, and knowledgeable nurses and midwives. This will be measured by auditing the emergency cases by the time the emergency was noted to end, the use of protocol, and the situation outcome.

Work plan

The work plan outlines the project plan, resource management plan, and steps necessary to complete a project (Sipes, 2020). By establishing specific deadlines and outlining the tasks required to achieve them, the PM can ensure that the project proceeds in an orderly and effective manner. For this project, the project manager will conduct a training and mentorship program for the unit staff on triggers of emergencies proper monitoring of patients, and preparedness from May to July 2022. Next, the project manager will audit all emergency cases with the team involved and evaluate what was done right and what could improve to adjust and learn. Another task will be the performance of emergency drills to see if the team is well equipped in terms of skills and resources. The Effectiveness of Training in Emergency Obstetric care Discussion

Estimated Timeline

The timeline for the project is six months within which the project is expected to be completed. At this time, the project manager will schedule each project phase to fit into estimated timeframes.

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References

Ameh, C. A., Mdegela, M., White, S., & van den Broek, N. (2019). The effectiveness of training in emergency obstetric care: a systematic literature review. Health policy and planning, 34(4), 257-270. https://doi.org/10.1093/heapol/czz028

Carson-Marsh, R., Aimone, A., Ansumana, R., Swaray, I. B., Assalif, A., Musa, A., … & Jha, P. (2022). Child, maternal, and adult mortality in Sierra Leone: nationally representative mortality survey 2018–20. The Lancet Global Health, 10(1), e114-e123. https://doi.org/10.1016/S2214-109X(21)00459-9

Collier, A. Y., & Molina, R. L. (2019). Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. NeoReviews, 20(10), e561–e574. https://doi.org/10.1542/neo.20-10-e561

Pattinson, R. C., Bergh, A. M., Ameh, C., Makin, J., Pillay, Y., Van den Broek, N., & Moodley, J. (2019). Reducing maternal deaths by skills-and-drills training in managing obstetric emergencies: A before-and-after observational study. South African Medical Journal, 109(4), 241-245. http://dx.doi.org/10.7196/samj.2019.vl09i4.13578

Sipes, C. (2020). Project Management For the Advanced Practice Nurse (2nd Ed.).  The Effectiveness of Training in Emergency Obstetric care Discussion