Goldberg Yael, Shahaf Poria, Zahran-Khoury Hazar, Reuveni Amit, Leder Anat, Lavie Ofer, Kedar Reuven
Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel.
Patient Safety and Risk Management Office, Clalit Health Services Headquarters, Tel Aviv, Israel.
Harefuah. 2022 Mar;161(3):183-187.
Poor obstetric consequences of unexpected events in the delivery room, such as a shoulder dystocia and umbilical cord prolapse at birth or severe maternal infection cause harm to the mother, the newborn, the extended family and the staff. A vigorous attempt has been made to anticipate or prevent those events and try to deal with them skillfully and quickly in order to reduce the rate of complications. One of the methods to bring about successful treatment of these events is by integrated staff training in the delivery room, that is, joint training of obstetricians, midwives in the field of nursing, and anesthesiologists. The PROMPT (Practical Obstetrics Multi Professional Training) method has proven effective in improving medical outcomes in cases of shoulder dystocia at birth, significantly improving the response rate in birth management with changes in fetal monitoring and reducing the rate of neonates with a low Apgar score at birth. The training method was brought from England and was recently taught by joint teams from two Clalit hospitals. The system trained local "coaches" from the medical staff, whose task would be to bring the training at all stages into the hospitals selected for the task. The training stages, which take place inside the delivery rooms and not in training centers as is customary today, include practicing selected cases with players, using practice dolls, dedicated flow charts and customized action boxes, as well as creating a sharing atmosphere and improving communication among staff members. In the advanced stage, training programs will be prepared for additional delivery rooms and we will be able to monitor and document a change for the better in managing such events in the future.
产房意外事件,如分娩时的肩难产和脐带脱垂,或严重的产妇感染,会给母亲、新生儿、大家庭和医护人员带来不良产科后果。人们已做出积极努力来预测或预防这些事件,并试图巧妙、迅速地应对,以降低并发症发生率。成功治疗这些事件的方法之一是在产房进行综合人员培训,即产科医生、护理领域的助产士和麻醉师联合培训。事实证明,PROMPT(实用产科多专业培训)方法在改善分娩时肩难产病例的医疗结果方面有效,通过改变胎儿监测显著提高了分娩管理的反应率,并降低了出生时阿氏评分低的新生儿比例。这种培训方法从英国引进,最近由两家克拉利特医院的联合团队授课。该系统培训了来自医务人员的当地“教练”,他们的任务是将各个阶段的培训引入选定执行该任务的医院。培训阶段在产房内进行,而非像现在通常那样在培训中心进行,包括与参与者演练选定病例、使用练习模型、专用流程图和定制行动箱,以及营造分享氛围并改善工作人员之间的沟通。在高级阶段,将为更多产房准备培训计划,我们将能够监测并记录未来在处理此类事件方面的改善情况。