Southmead Maternity Unit is part of the North Bristol NHS Trust and manages over 6,000 deliveries each year. The unit is very focused on patient safety and started multi-professional practical obstetric emergencies training in year 2000. 

Why simulation training?

Substandard care: The Confidential Enquiries into Maternal Deaths (CEMD) and The Confidential Enquiries into Stillbirths and Deaths in Infancy (CESDI) have repeatedly identified substandard clinical care as a major contributor to maternal deaths and fetal and neonatal mortalities.

Breech presentation demon-
strated by two instructors.

Patient safety: The inquires contributed to a growing focus on patient safety in the UK. As a result, the government issued new training requirements for the National Health Service (NHS) in 2000.

More simulation training: Southmead Maternity Unit was already utilizing simulation at the time, but decided to integrate simulations more fully within their local staff training program as the new training requirements came into effect.

Core training principles 

1. Multi-professional teams: All maternity staff, regardless medical background, are allocated a non-clinical day to attend the local training course. Having midwives, obstetricians, anesthesists and health care assistants train together generates many benefits. Key organizer Cathy Winter highlights the importance of training and learning in the teams that would attend emergencies in real life and communication between obstetricians and midwives as some of the major benefits multi-professional simulation training.

2. Ownership: The training days are developed 'in house' by a multi-professional team and are 'owned' by the unit. Winter says this helps everyone feel part of it. With ownership comes pride in your work and everyone can contribute their ideas to enhance the training program.

Hybrid simulation: The integration of MamaNatalie
with a patient actor allows the team to practice both
communication skills and post partum hemorrhage.

3. In situ training: Dr Joanna Crofts says that ''In addition to well known advantages like having people who normally work together train together using the equipment they normally use; in situ training is also more cost effective, as there is no need for specific training facilities'' and that ''having local experts to facilitate the simulations yields higher competency levels in general.''

4. Non-threatening atmosphere: People used to worry about training, but the non-threatening atmosphere has changed that. Now people expect to train and there is no problem with staff attending, explains Winter. 

Each scenario is followed by a short debriefing session from within the team themselves, using structured clinical and teamwork checklists. There is always an emphasis on what the team did well. Again, the aims are to create a non-threatening, friendly atmosphere, where everyone feels happy to ask questions.

5. Mandatory training: Once a year all maternity staff (midwives, obstetricians, obstetric anesthetists and health care assistants) are allocated a non-clinical day to attend the local training course. To accomodate training for everyone, the training days (Intrapartum Update Days) are facilitated every 4-6 weeks.

Interactive lectures, workshops, and practical simulations

Each training day starts with theoretical sessions and workshops on topics relevant to pregnancy and maternity care. After lunch the participants are divided into six multi-professional teams comprising midwives, obstetricians, anaesthesists, healthcare assistants and students.

Maternal collapse: CPR and emergency
c-section are performed simultaneously
to save both mother and child.

Frequently used scenarios

Eclampsia, Cord prolapse, Shoulder dystocia, Twin delivery, Vaginal breech delivery, Maternal collapse, Sepsis, Inverted uterus, Ruptured uterus, Antepartum hemorrhage, Post partum hemorrhage, Neonatal resuscitation, Theatre practice update.

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