1. The debriefing checklist outlines steps for assessing a patient in labor and delivery, including taking a report, washing hands, introducing oneself, checking vitals, and performing a vaginal exam. 2. The nurse is to delegate tasks to an assistant nurse, such as obtaining supplies, starting an IV, drawing labs, and applying the fetal monitor. 3. Communication is important, with nurses verbalizing each task and reporting back findings to the patient and team. 4. A thorough patient assessment is conducted regarding contractions, fetal heart rate, medical and pregnancy history.

1. Debriefing Checklist
Action
Completed
Completed
correctly
Action and Detailed Description of What Should be Done Yes No Yes No Notes
Takes report from Labor and Delivery secretary.
Someone assumes role of leader and delegates tasks.
Washes/sanitizes hands before entering patient room.
Knocks.
Introduces self.
Provides privacy.
Checks patient armband.
Leader delegates assistant nurse to obtain urine specimen
cup and gown.
Assistant nurse verbalizes, “I will get a specimen cup and
gown.”
Assistant nurse obtains specimen cup and gown.
Asks patient to change into gown.
Asks patient to provide a urine specimen and gives clear
and correct instructions.
Leader delegates assistant nurse to perform safety check.
Assistant nurse verbalizes, “I will perform the safety check.”
Performs safety check for oxygen tubing and suction
device.
Performs safety check for ambu bag.
Leader delegates assistant nurse to take vitals.
Assistant verbalizes, “I will take the vitals”.
Assistant takes patient vitals: (99.0F BP 130/87 P 85 R 18
SpO2 99% pain 5/10).
Leader delegates assistant nurse to place external
tocodynamometer and external fetal monitor on patient.
Assistant nurse verbalizes, “I will place the external
tocodynamometer and external fetal monitor on the patient.”
Applies external tocodynamometer and external fetal monitor

2. on the patient.
Assesses fetal heart rate monitor and tocodynamometer.
Asks patient what she came in for today.
Asks patient if she has been experiencing any
cramping/contractions.
Asks patient how long she has been experiencing
contractions.
Asks patient about character of contractions including
frequency and duration.
Asks patient the date of her LMP.
Asks if patient has received any prenatal care
Asks patient if she has any vaginal bleeding
Asks the patient if she has had any fluid leaking
Asks patient about fluid intake and whether it has decreased.
Asks the patient about pain level.
Ask patient about medical history.
Asks patient about gynecological history.
Asks patient about previous pregnancies.
Explains to patient that a VE will be performed.
Dons sterile gloves.
Checks for vaginal bleeding.
Performs vaginal exam.
Tells patient vaginal exam findings.
Nurse assesses psychological status/support system.
Nurse offers to contact support system.
Nurse documents verbal consent to inform mother.
Leader delegates for assisting nurse to call mother
Assistant verbalizes, “I will call the patient’s mother”.
Leader nurse verbalizes, “I will call the doctor”.

3. Leader has all relevant information needed to call MD.
Leader knows MD name.
Leader has pen and paper ready.
Leader gives brief but thorough report to MD.
S: Ms. Smith in room “SIM suite” is in preterm
labor at 32 weeks gestation..
B: She has received no prenatal care.
A: VE reveals 1 cm cervical dilation,5%, 0 station,
UCs every 3 minutes of strong intensity and 60 seconds
duration, and early decels. Vitals are T 99.0F BP 130/87 P
85 R 18 SpO2 99% pain 5/10.
R: Nurse suggests ordering fetal fibronectin test, CBC,
CMP, UA, fluid bolus, GBS testing, administering and
Terbutaline.
R: Repeats back what MD says.
Assistant nurse calls and informs mother that patient is in
labor and is requesting her presence.
Nurse employs de-escalation techniques to calm mother.
Leader reports, “I called the doctor”.
Leader informs patient of doctors decision to perform fetal
fibronectin test, CBC, CMP, UA, fluid bolus, GBS testing,
and administer Terbutaline.
Leader delegates assistant nurse to collect IV supplies,
establish IV, and draw labs.
Assistant nurse verbalizes, “I will collect IV supplies,
establish an IV, and draw labs”.
Nurse collects IV supplies and vacutainer.
Nurse establishes venous access and draws labs.
Nurse flushes IV.
Nurse obtains Terbutaline and LR.
Nurse verifies terbutaline and LR dosage/rate with order
and patient ID, and performs five rights of medication
administration.
Nurse educates patient about purpose of LR bolus.

4. Nurse spikes and hangs LR bolus by gravity.
Nurse educates patient about purpose of terbutaline.
Nurse draws up terbutaline.
Nurse administers tocolytic (terbutaline) subcutaneously.
Leader delegates assistant nurse to gather swab.
Assistant nurse verbalizes, “I will get the swab.”
Nurse obtains swab for GBS.
Nurse educates patient about purpose of GBS swab.
Nurse swabs vagina and rectum for GBS testing.
Leader delegates assistant nurse to sent blood and GBS
swab to lab.”
Assistant nurse verbalizes “I will send the blood and GBS
swab to lab.”
Nurse sends blood and GBS swab to lab.
Nurse assesses FHR monitor and tocodynamometer and
notes FHR at baseline and cessation of UCs.
Simulation ends.

5. Peer Lead High Risk Scenario
Preparation Form – Simulated/Standardized Patient
SCENE #1 Patient Type: Simulated Patient ¨ Standardized Patient (LIVE)
A
-
B
-
C
Airway:
Upper Airway Sound: XNormal ¨ None ¨ Stridor, Insp. ¨ Stridor, Exp. ¨ Stridor, Bi. Laryngospasm: Y ¨ N ¨
Breathing:
Resp. Pattern: XNormal ¨ Kussmaul’s ¨ Cheyne-Stokes ¨ Biot’s ¨ Apneustic ¨ Apnea
Left Lung: X Normal None ¨ Wheezing ¨ Insp. Squeaks ¨ Crackles ¨ Rales Resp.
Rate:16___ Insp. Time:_____
Right Lung: X Normal ¨ None ¨ Wheezing ¨ Insp. Squeaks ¨ Crackles ¨ Rales OSat:_99____
EtCO2:_____
Circulation: Heart Rate:_75____ Blood Pressure: Systolic:127__ Diastolic:_84____
Rhythm: _NSR_____________________________________________________________________
Absent Pulses: 75 Radial Left 75 Radial Right
Heart Sound: XNormal ¨ None ¨ Distant ¨ Systolic Murmur ¨ S3 ¨ S4 Sinus Arrhythmia: Y ¨ N
Other:
Temperature:°C Seizures: X None ¨ Mild ¨ Severe Hemorrhage: Y ¨ N ¨ Uterine Pressure:_N/A____
Eye State: ¨ Closed ¨ X Open X Spontaneous Opening ¨ 5 Blinks/min 10 Blinks/min ¨ 15 Blinks/min
Enable Rxn: ¨ Left Pupil ¨ Right Pupil Time(Sec):_____
U
A
-
F
H
R
UA:
Contraction Frequency: __3___ min. Duration:__60___sec. Resting Tone:_N/A____mmHG Coupling:
_____% Probability _____% Size
TOCO: ¨ No Contractions ¨ Mild Moderate ¨ Strong ¨ IUPC:__ ___mmHg
FHR: Baseline:_135____ bpm
Pattern: ¨ Accel ¨ X Decel ¨ Prolonged Accel ¨ Prolonged Decel Accel/Decel Intensity: ¨ Subtle ¨
XAverage ¨ Dramatic
Variability ¨ None ¨ Absent ¨ Minimal Moderate ¨ Marked ¨ Sinusoidal
Episodic Changes: None ¨ Non Reactive ¨ Reactive ¨ Prol/Accel ¨ Prol/Decel
Periodic Changes: ¨ None ¨ Uniform Accels ¨ Early Decels ¨ Late Decels
Variable Changes: None ¨ Mild ¨ Moderate ¨ Severe
L
O
G
I
S
T
I
C
S
Sim-Patient Details: Name: __Emily Smith__ Age:__17_ Gender: ¨ Male Female Race: _Caucasian_
Staged Supplies:
Fetal heart rate monitor Gown
Tocodynamometer
Vital signs machine
IV pole
Chux
Sterile gloves

6. BOA kit
Terbutaline/syringe
LR/tubing
Nitrazine paper
Standing Supplies:
Call light to contact nurse Swabs
Clean gloves IV start kit
Hand sanitizer Vacutainer
Chux Sterile specimen cup
O2 mask
Phone
Linens
Moulage Requirements: Wet chux under patient Specimen cup filled with
“urine”
Pelvis for vaginal
exams/ROM/birth
Peer Lead High Risk Scenario
Preparation Form – Simulated/Simulated Patient
ENSE
MBLE
Sim/Stand-Patient Details: Name: Emily Smith Age:___17__ Gender: ¨ Male X Female Race: Caucasian
Mood/Affect: ¨ Hostile ¨ X Worried Calm ¨ Excited ¨ Depressed ¨ X Other: Anxious
Communication: Articulate ¨ X Talkative ¨ Withdrawn ¨ Other:
Openness: ¨ Deceptive ¨ Evasive X Forthcoming ¨ Talkative ¨ Other:
Agenda: ¨ No X Yes, explain: ______ Worried about labor, her preterm baby’s well-being, and about telling her
mother who does not know that she is pregnant.
Relevant History/Prompts: High risk G1P0 patient is 32 weeks pregnant and in preterm labor. The patient is
anxious/worried and her family does not know about the pregnancy. Additionally, the patient is worried about her
baby’s well-being.
Cast Details: Name: Nurse Cindy Age:___30____ Gender: ¨ Male X Female Race: TBA
Relationship to Patient: ¨ Parent ¨ Spouse ¨ Sibling ¨ Child ¨ Physician X Nurse ¨ Other:
Mood/Affect: ¨ Hostile ¨ Worried ¨ Calm ¨ Excited ¨ Depressed X Other: Annoyed
Communication: X Articulate ¨ Talkative ¨ Withdrawn ¨ Other: Brief
Openess: ¨ Deceptive ¨ Evasive ¨ Forthcoming ¨ Talkative X Other: Somewhat vague
Agenda: ¨ No X Yes, explain: Judgemental of teenage pregnancy.
Relevant History/Prompts:N/A
Other: Someone will need to play voice of the doctor.

7. Other: Someone will need to play voice of the mother.
Someone may need to be charge nurse if the group gets off track.
Interdisciplinary Order Sheet
Date/Time Service Labor and DeliveryPhysician Orders (presented if nurse delivers all
relevant information to doctor and suggests relevant orders)
04/13/16 OB Admit to Labor and Delivery
Diagnosis: Preterm labor (32 weeks gestation with no prenatal care)
Level of care: high risk
Allergies: NKDA
Vital Signs: Per Protocol
Fetal Monitoring: Continuous
Activity: Bathroom privileges
Oxygen: at 8 L per minute via face mask for non-reassuring heart beat
Diet: NPO
Fluids:
500 ml bolus of Lactated Ringers to infuse over 20 minutes for decreased
blood pressure or nonreassuring fetal heart rate.
Medications:
Zofran 2mg IVP Q 2 hours prn nausea and vomiting
Acetaminophen 325 mg 2 tabs Q 4 hours prn mild pain, not to exceed 12
tabs/ day for a duration of 3 days.
Terbutaline 0.25 mg. SQ q. 1-3 hrs prn preterm contractions. Do not give
if HR >110-120 bpm.
Labs:
Urine dipstick
HIV Rapid test (if there is no documentation of prenatal HIV test result,
unless patient declines)
CBC without diff
CMP

8. Type and Screen
GBS swab testing
Fetal fibronectin test
Ordered by: Dr. Robertson Date: 04/12/16 Time: 12:00
Verified by: Nurse Sim Date: 04/13/16 Time: 12:00

9. High Risk Flow Chart
1. How is your scenario starting & what information if any is given during report?
Secretary transfers care of patient to nurse for triaging in the labor and delivery unit and reports
the patient presented with complaints of cramping, but no assessment has occurred. Secretary
communicates with an annoyed affect. No further information is given. No one is at the bedside.
The nurse enters the room to introduce his/herself to the patient.
2. What is patient doing and what is the affect?
The patient is agitated and anxious and complaining of pain in the lower back radiating to the
front of the abdomen at 5/10.
3. What is significant other doing and what is the affect?
No one is at bedside, but the patient requests that the nurse call her mother and inform her of
the situation and ask her to come be with the patient. When the nurse calls the patient’s mother,
the patient’s mother is furious and combative.
4. What are initial vital signs? Initial Findings: T 99.0F BP 130/87 P 85 R 18 SpO2 99%
pain 5/10.
5. What does fetal monitor show (initially or when attached?)
Initially FHR monitor shows moderate variability with a baseline heart rate of 135.
Tocodynamometer shows UCs every 3 minutes of mild intensity of 60 second duration.
6. What are first changes in vital signs or fetal monitor?
The tocodynamometer now indicates UCs every 2 minutes of moderate intensity with a duration
of 60-70 seconds. Fetal heart rate monitor begins to show early decelerations with baseline
dropping to 125 and moderate variability.
7. What are changes in patient’s condition?
Patient begins complaining of increasing anxiety and worsening pain in lower back radiating to
the front of the abdomen. Patient is now 1 cm dilated, 75% effaced, 0 station. FHR is stable at
125 with moderate variability. Vitals are T 99.0F BP 130/87 P 85 R 18 SpO2 99% pain 5/10.
8. Subsequent changes if correct interventions?
Doctor is called and nurse reports patient is a 17 year old at 32 weeks gestation with no
prenatal care. Patient’s condition is correctly reported including the following information: VE
1/5/0, UCs every 3 minutes, BOW intact, and FHR 135 with moderate variability and early
decelerations. Nurse reports patient is complaining of increasing pain radiating from the lack of
the abdomen to the front. Terbutaline 0.25 mg SQ q1h prn and LR 500 mL bolus are prescribed.
CBC, CMP, GBS testing, UA, and Fetal Fibronectin test are ordered. Nurse established IV
access, draws labs, and collects swab and urine sample. The nurse administers Terbutaline and
LR bolus. Nurse Patient reports relief of UC pain and monitor shows UCs are resolved.
9. Subsequent changes if incorrect interventions?
Doctor is not contacted and terbutaline and LR bolus are not prescribed and administered. UCs
progress to every 2 minutes, moderate intensity, and lasting 70-80 seconds. BOW breaks.
Patient anxiety and pain worsen. Patient states, “Why aren’t you doing anything for my baby?”
Patient is now 5 cm dilated, 90% effaced, 0 station. Vitals are T 99.0F BP 131/88 P 88 R 18
SpO2 99%. FHR remains at 125 with moderate variability. Patient complains of increasing
pelvic pressure, stating “The pressure is getting worse and worse, I feel like the baby is coming
down.”
10. Subsequent changes if correct interventions?
Nurse perform VE, confirms ROMwith nitrazine paper, and immediately checks FHR monitor for
changes and vagina for prolapsed cord or meconium. Doctor is called and nurse reports patient
is a 17 year old at 32 weeks gestation with no prenatal care. Patient’s condition is correctly

10. reported including the following information: progression from 1/75/0, UCs every 3 minutes,
BOW intact, and FHR 135 with moderate variability to 5/90/0, UCs every 2 minutes of moderate
intensity with a duration of 70-80 seconds, BOW broken, and FHR 125 with moderate variability
and early decelerations. Nurse reports patient is complaining of increasing pain radiating from
the lack of the abdomen to the front and pelvic pressure. Terbutaline 0.25 mg SQ q1hr prn and
LR 500 mL bolus are prescribed. CBC, CMP, GBS testing, and Fetal Fibronectin test are
ordered. Nurse established IV access, draws labs, and collects swab. The nurse administers
Terbutaline and LR bolus. Nurse Patient reports relief of UC pain and monitor shows UCs are
resolved.
11. Subsequent changes if incorrect interventions?
Doctor is not contacted and Terbutaline and LR bolus are not prescribed and administered.
FFN, GBS, CBC, and CMP are not ordered. Patient becomes increasingly pained and anxious.
Stating, “You don’t know what you’re doing and you are not helping me! You need to go get the
doctor now!” UCs now occur every 90 seconds, are of moderate intensity, and last 80-90
seconds. Patient is now 10 cm dilated, 100% effaced, and +2 station. Patient states, “The baby
is coming, I can’t wait anymore I have to push!” The nurse obtains the BOA kit and SVD of
premature baby occurs.

11. Laboratory Results
Prenatal Laboratory Results: TODAYS RESULTS (admitting results)
Test Result Normal Range
CBC
WBC 11.0 4.5-11.0 k/mm3
RBC 4.9 4.5-5.90 M/mm3
Hgb 13 12-16 g/dL
HCT 41 36-46 %
MCV 92 80-100 fl
PLT 321 150-450 k/mm3
TYPE & RH
Blood Type A O, A,B, AB, O
RH Positive Negative, Positive
Antibody Negative Positive or Negative
URINALYSIS
Color Yellow
Appearance Clear
Glucose Negative
Bilirubin Negative Mg/dL
Ketones Negative
Specific gravity 1.021 1.005-1.030
Blood Negative
pH 6.2 5-7
Protein Negative Mg/dL
Leuko Negative

12. HCG Positive Positive indicates pregnancy
Alpha Fetoprotein Negative Positive if 0.20 ng/mL or >2.5MoM
Hepatitis B Antibody Negative
Rubella Immune
HIV Negative
VDRL Negative
GBS Negative
Other Results (X-rays, Sonograms, etc.):
___No prenatal history on record at the hospital
____________________________________________________________________________
____________________________________________________________________________

13. Medication Administration Record
Patient Name: Emily Smith Medical record #: 12345678
Room #
Sim suite
Physician: Doctor Robertson Allergies:
NKDA
Age:17 Weight:120
lbs
Sex: F
Order date Medication, amount,
frequency, route
Shift Time/initials Time/initials Time/initials Time/initials Time/initials Time/initials
04/13/16 Lactated Ringers
500 ml Bolusto infuse
over 20 min. prn for
decreased blood
pressure or non-
reassuring fetal heart
rate.
7-3
3-11
11-7
04/13/16 Zofran
2 mg IVP
Q2 hoursprn
for nauseaand
vomiting
7-3
3-11
11-7
04/13/16 Acetaminophen
325 mg
2 tabsQ4H
not to exceed 12 tabs/
day for aduration of3
days for mild pain
7-3
3-11
11-
04/13/16 Terbutaline
0.25 mg SQ
q 1hr prn for preterm
contractions
7-3
3-11
11-7
Date Initial Signature Date Initial Signature