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Failure modes and effects analysis to assess COVID-19 protocols in the management of obstetric emergencies

The Royal Free Hospital is one of four High Consequence Infectious Disease centres in England and as of the end of May 2020, seven women were confirmed COVID-19 peri-delivery. We developed a standard operating procedure (SOP) for suspected and confirmed COVID-19 women undergoing operative delivery....

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Autores principales: Curtis, Sam, Flower, Rebecca, Emanuel-Kole, Lola, Nadarajah, Premala
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936552/
https://www.ncbi.nlm.nih.gov/pubmed/35516829
http://dx.doi.org/10.1136/bmjstel-2020-000747
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author Curtis, Sam
Flower, Rebecca
Emanuel-Kole, Lola
Nadarajah, Premala
author_facet Curtis, Sam
Flower, Rebecca
Emanuel-Kole, Lola
Nadarajah, Premala
author_sort Curtis, Sam
collection PubMed
description The Royal Free Hospital is one of four High Consequence Infectious Disease centres in England and as of the end of May 2020, seven women were confirmed COVID-19 peri-delivery. We developed a standard operating procedure (SOP) for suspected and confirmed COVID-19 women undergoing operative delivery. This was revised in response to our ongoing clinical experience and changes in guidance from medical and public health organisations. Following 10 weeks of clinical practice, we formally tested the SOP using point-of-care simulation to enable optimisation for a potential second surge. Our high-fidelity simulation of a COVID-19-positive parturient requiring an emergency caesarean was facilitated by the simulation team in our obstetric unit. It was designed to test the performance and safety of our SOP as well as staff performance. We used the Failure Modes and Effect Analysis tool (a systematic, prospective method of process mapping) to identify how a complex task might fail and assess the relative impact of different failures. The decision-to-delivery was 17 minutes, which we considered to be successful. However, a number of operational deficiencies were identified. The main failures related to lack of situational awareness, ill-fitting personal protective equipment and difficulties communicating between theatre and the neonatal teams located outside, posing serious potential risks to safe neonatal care. Subsequently, we have modified our SOP to include a communication check, implemented communication training for the neonatal team and organised further simulation training for theatre staff unfamiliar with COVID-19 considerations.
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spelling pubmed-89365522022-05-04 Failure modes and effects analysis to assess COVID-19 protocols in the management of obstetric emergencies Curtis, Sam Flower, Rebecca Emanuel-Kole, Lola Nadarajah, Premala BMJ Simul Technol Enhanc Learn Short Report The Royal Free Hospital is one of four High Consequence Infectious Disease centres in England and as of the end of May 2020, seven women were confirmed COVID-19 peri-delivery. We developed a standard operating procedure (SOP) for suspected and confirmed COVID-19 women undergoing operative delivery. This was revised in response to our ongoing clinical experience and changes in guidance from medical and public health organisations. Following 10 weeks of clinical practice, we formally tested the SOP using point-of-care simulation to enable optimisation for a potential second surge. Our high-fidelity simulation of a COVID-19-positive parturient requiring an emergency caesarean was facilitated by the simulation team in our obstetric unit. It was designed to test the performance and safety of our SOP as well as staff performance. We used the Failure Modes and Effect Analysis tool (a systematic, prospective method of process mapping) to identify how a complex task might fail and assess the relative impact of different failures. The decision-to-delivery was 17 minutes, which we considered to be successful. However, a number of operational deficiencies were identified. The main failures related to lack of situational awareness, ill-fitting personal protective equipment and difficulties communicating between theatre and the neonatal teams located outside, posing serious potential risks to safe neonatal care. Subsequently, we have modified our SOP to include a communication check, implemented communication training for the neonatal team and organised further simulation training for theatre staff unfamiliar with COVID-19 considerations. BMJ Publishing Group 2020-11-17 /pmc/articles/PMC8936552/ /pubmed/35516829 http://dx.doi.org/10.1136/bmjstel-2020-000747 Text en © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. https://bmj.com/coronavirus/usageThis article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
spellingShingle Short Report
Curtis, Sam
Flower, Rebecca
Emanuel-Kole, Lola
Nadarajah, Premala
Failure modes and effects analysis to assess COVID-19 protocols in the management of obstetric emergencies
title Failure modes and effects analysis to assess COVID-19 protocols in the management of obstetric emergencies
title_full Failure modes and effects analysis to assess COVID-19 protocols in the management of obstetric emergencies
title_fullStr Failure modes and effects analysis to assess COVID-19 protocols in the management of obstetric emergencies
title_full_unstemmed Failure modes and effects analysis to assess COVID-19 protocols in the management of obstetric emergencies
title_short Failure modes and effects analysis to assess COVID-19 protocols in the management of obstetric emergencies
title_sort failure modes and effects analysis to assess covid-19 protocols in the management of obstetric emergencies
topic Short Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936552/
https://www.ncbi.nlm.nih.gov/pubmed/35516829
http://dx.doi.org/10.1136/bmjstel-2020-000747
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