Terri L. Cole, DNP, MSN, RN, NE-BC

Abstract:

Background: Interdisciplinary collaboration of the labor & delivery team during their urgent cesarean huddles was not conducive to prompt decision-making. These delays led to unfavorable outcomes for the mother and baby, signifying a need for improvement in their process and a shared mental model in conducting this important huddle and their decision process. Objectives: An estimated 47% of cesarean delivery complications are attributed to delayed or fractured communication. This quality improvement project objective, using a pre and post-survey, is to improve the shared mental model of the team through their values, beliefs, and attitudes. Methods: A convenience sample of 24 participants, consisting of registered nurses and physicians, the Jefferson Scale of Attitudes Towards Nurse/Physician Collaboration (JSATNPC) was distributed as pre and post-survey before and after role-play simulation exercises. The teams used a briefing checklist and the TeamStepps concepts of checkback, the two-challenge rule, and Concern, Uncomfortable, and Safety. Results: This QI project did not improve the decision-to-incision times of the labor and delivery team. The pre-intervention mean and median time was 66.1 and 28 minutes, respectively; and the post-intervention scores were a mean of 116.6 and a median of 98 minutes. There were 24 pre-surveys of the (JSATNPC) and one post-survey completed. Conclusion: Several physicians and nurses were supportive and appreciative of the structure applied to their briefing. The team held the same concern for the safety of the mother and baby but did not have the support in organizing their process. The DNP student has returned to the project site to organize a team and revisit implementing the project with an assigned team and committed stakeholders.

Click here to see the full manuscript.