OB Rapid Response Team

Purpose
To reduce adverse outcomes by preventing clinical
deterioration in the obstetric patient or fetus with
early effective interventions
Standardize an organized team approach to OB
Emergencies
Is high priority for patient safety risk
Goals and Measurements
1. Improve
communication in
emergencies
2. Improve patient safety
3. Improve efficiency in
emergencies



1. Measured by staff
perception with survey
2. Measured by staff
perception with survey
3. Measured in times
1. DecisionOR
2. ORBaby
3. Staff perceptions

Charting
Doc Flowsheets
Delivery times
Decision for C/S
time
Move to OR time
Delivery
Summary
C-Section
OR IN time is
charted as
Procedure
Start time
OR Brief/Debrief Form
Added question on OR Debrief Form
Was the OBRRT used in this case?
What were the strengths?
What were the weaknesses?
Timeline
8/20/2013
Emailed staff for
interested team
members
9/9/2013
Implement OBRRT
Committee
Order Pagers
Talk with Dispatch
November 20
th
First OBRRT
Meeting discussing
plan
Week of 11/10/13
Send out Pre-data
Survey to staff
December and
January Stat C/S
Simulations
January 2014 Educate
Staff:
Staff Meetings
OB Team Meeting
Skills lab poster
Weebly
End of
January/Beginning
of February
OBRRT Roll Out
Spring 2014
Post-data Survey
Data Collection for
OR times
Educating
About 1-2% of
pregnancies are
complicated by an
obstetrical emergency
In the majority of
perinatal death and
injury cases, the root
causes are related to
problems with
organizational culture,
communication and
team work


Specified Obstetric Emergencies
Severe bradycardia
Hemorrhage
Eclampsia
Maternal cardiac arrest
Shoulder dystocia
Cord prolapse
Any potential serious emergency in which a team
response is required

How to Activate
OB Rapid Response Team can be paged
by 84757
Operator will immediately pick up and
take your request
You will say I need the OB Rapid
Response Team to Room # This will
send out an immediate page to
designated team members


How to Activate
The OB Rapid
Response Team can
be activated by any
nurse, midwife or
physician team
member
You will need to
send a separate
page if you need the
Peds team
It is the same
number 84757
Staff Assist Vs. OBRRT
The OBRRT is not replacing the Staff Assist button
Feel free to use the Staff Assist button when needing
fast nursing assistance
Important to crowd control with Charge Nurse,
Primary Nurse and 1-2 Nurses at the bedside
The OBRRT will include nursing as well as physician
and anesthesia assistance
Keep in mind patient privacy when responding at the
bedside
February 2014 Team Members
Go Live with our first OB
Rapid Response Team
This will consist of both
Womens Care Center
and Birth Center
In future, hope to expand
team response to
outpatient clinics
OB Attendings
Anesthesia Resident
and CRNA
Scrub techs
Charge Nurses
Resource Nurses

OBRRT
Resource Nurse Role
Labor Nurse
Charge Nurse will assign per shift
Role and pager will be handed off if Resource Nurse
is 1:1 with her patient and continually at the bedside
Will use magnet on patient white board to designate
Resource Nurse for that shift
Ideally the nurse waiting for next labor, an early
induction or lower risk patient should be assigned if
possible
Emergency Roles
Above the
Waist Nurse
Below the
Waist Nurse
Resource
Nurse
Assists patient above waist
Administers medications
Initiates Oxygen
Draws labs
Maintains IV line
Assists patient below the waist
Circulator in patient room
Assist OB/CNM with delivery
Gives report to appropriate
personnel
Charter/Recorder
Assists Primary and Charge RN
Peds assist
Runner
Updates family
Helps with Charting

Standardizing Nursing Roles in OR
Charge
Nurse
Primary
Nurse
Resource
Nurse
Above the waist RN
Team leader- delegates needs
Meds
Anesthesia Assist
Blood tubing
Below the waist RN
Circulator
Foley
Bovie
Time Out
Coordinates Peds Team
Left tilt
Heart tones
Prep
Extra Staff Roles
Staying near by but not entering room unless
directed
Take labs and specimens to send
Retrieve blood products
Runners
Runs for equipment and supplies stating I am going to get


Closed Looped Communication
It is the expectation that each team member
introduces themselves, their roles, and uses closed
loop communication
Speaks clearly
Uses names
Uses eye contact




Closed Loop Communication
Example:
In an Emergency
Sender: Katie, can
you get OR meds?
Katie: Yes I am
going to get OR
meds
Sender: Thanks,
Katie
Receiver
accepts
message,
provides
feedback
confirmation
Sender
verifies
message
was
received
Sender
initiates
message
Projected Changes
Paging system
Standardized Roles
Resource Nurse Role
Hope to eventually have a flowsheet template for
utilization of OBRRT and/or Emergency
interventions
Will require a written Guideline
Supplies needed:
Full sized Dummy for Simulations
Pagers