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  1. 1. Labor & Delivery Crisis Resource Management Course The Center for Medical Simulation 65 Landsdowne St., Cambridge, MA 02139; 617-768-8900 Introduction Patient safety is an integral component of healthcare and many efforts are underway to reduce medical errors and the injuries and malpractice claims that result from them. Obstetrical and surgical adverse events often involve failures of team performance. The increasingly high cost of obstetrical malpractice claims has made patient safety and error reduction priorities for loss prevention interventions, with a focus on interventions that improve teamwork and communication. Simulation based training has been used by Anesthesia, Emergency Medicine and Neonatology for several years to refine teamwork and procedural skills. The Anesthesia Departments of Harvard Medical School (HMS) has been working with the Center for Medical Simulation (CMS) since 1994, teaching skills such as leadership, communication, and resource and support management techniques necessary for effective team performance during critical events. All Anesthesia faculty of Harvard-affiliated hospitals actively participate in simulation-based training and receive malpractice insurance premium discounts. The Center for Medical Simulation and Risk Management Foundation of the Harvard Medical Institutions (RMF) offers a Labor and Delivery Crisis Resource Management (CRM) course specifically for Obstetrical nurses, Obstetricians, and Anesthesiologists. This Labor and Delivery CRM course qualifies as one of the required elements that RMF’s Controlled Risk Insurance Company (CRICO) insured Obstetricians must complete to take advantage of a 10% per year discount of annual malpractice premiums for three years. Full requirements that obstetricians need to qualify for rate reduction of CRICO insurance premiums are available through RMF’s website at . The fee, payable by cash, check, or money order, for the Labor & Delivery course is: CRICO Insured Obstetricians: $950; Obstetrical nurses: $150 We apologize for any inconvenience, but we are unable to accept credit card payments. -1- rev.6.05_rmf
  2. 2. Course Description Learning Teamwork and Crisis Resource Management for Labor and Delivery Physicians and Nurses is an experiential six hour program focusing on event management during simulated clinical practice. Participants include Obstetricians, Obstetrical Nurses and Obstetrical Anesthesiologists who collaborate and work in teams during simulated obstetrical events. The Center for Medical Simulation (CMS) provides a realistic medical setting, equipped with all the supplies and devices normally found in Labor and Delivery, where simulated clinical scenarios and obstetrical procedures are conducted using computerized mannequins and fetal heart rate simulator equipment. Some obstetrical procedures that cannot be easily simulated will require the participant to play-act. Simulated events will be videotaped so that teammates can view their performance in structured group debriefings facilitated by trained CMS instructors. Practice and supportive feedback will be provided to improve teamwork skills that can enhance error prevention, recognition and management in actual clinical settings. The course curriculum is derived from review of obstetrical claims data, consultation with obstetrical leadership, experiences with Anesthesia CRM courses, and feedback from L&D CRM programs that have been held over the past two years: Labor & Delivery Crisis Resource Management Course Curriculum I. Factors degrading long-term vigilance in Labor & Delivery A. Work overload. B. Hubris. C. Production pressures. D. Fixation-sticking with mental models that seem rational but aren't. E. Tolerance and accommodation. F. Fatigue. II. Communication strategies A. Sharing information with all team members. B. Closed-loop communications. C. Knowing your and your teammates roles, knowledge, skills and abilities. D. Calling for help. E. Assertiveness techniques. -2– rev.6.05_rmf
  3. 3. III. Strategies for managing and disclosing medical errors A. Being accountable as a team member. B. Talking about error with your teammates. C. Apologizing without assigning blame. D. Talking about error with patients and their family members. IV. Developing a culture of communication A. Briefing. B. Debriefing. C. Surgical Pause. ### -3– rev.6.05_rmf