Nurses' Knowledge of and Confidence in Perioperative Skills for Emergency Cesarean Birth.

OBJECTIVE: To assess if nurses' perioperative knowledge of and confidence in perioperative skills for emergency cesarean birth improved after didactic learning and high-fidelity simulation. DESIGN: Descriptive, one-group pretest and posttest design. SETTING/LOCAL PROBLEM: Level 3 labor and birth unit that averages 3,000 births per year. At the site, there were no current evidence-based programs specifically focused on perioperative skills sustainment of the maternity nursing professional. PARTICIPANTS: Registered nurses on a labor and birth unit with at least 1 year of experience completed an online educational course and simulation activity. INTERVENTIONS/MEASUREMENTS: Participants were given pretests and posttests to assess knowledge and confidence in emergency cesarean birth perioperative skills. Observations of nurses' pretest and posttest interventions in cesarean births were made to assess changes in competency. Chart reviews were completed to assess changes in decision-to-incision time before and after the intervention. RESULTS: Nurses reported greater confidence and knowledge during emergency cesarean birth after participating in the interventions. Other results included decreased decision-to-incision times. None of these results held statistical significance. CONCLUSION: This project highlights the need for evidence-based, standardized perioperative maternity education across labor and birth nursing practice.

Development of an obstetric vital sign alert to improve outcomes in acute care obstetrics.

Maternal morbidity and mortality is a national health problem. Causal analysis of near-miss and actual serious patient safety events, including those resulting in maternal death, within obstetric units often highlights a failure to promptly recognize and treat women who were exhibiting signs of decompensation/deterioration. The Obstetric Vital Sign Alert (OBVSA) is an early warning tool that leverages discrete data points in the electronic health record, calculating a risk score that is displayed as a visual cue for acute care obstetric staff. When studied in a cohort of women with postpartum hemorrhage, use of the OBVSA reduced symptom-to-response time and intervention time, as well as key process and outcome measures.