Last modified: Sunday, July 22, 2007 12:09 AM PDT Certified Nurse-Midwife Siri Jackman (from left), Terry Farrow, RN, and Cindy Snider, CNA, participate in a shoulder dystocia simulation Thursday at Holy Rosary Medical Center. The simulator comes from Treasure Valley Community College, and HRMC officials plan to hold new simulations in the Obstetrics department twice yearly. HRMC simulation program pays dividends By Jennifer Colton - Argus Observer Ontario - Doctors and nurses huddle around a patient in a room in the maternity department at Holy Rosary Medical Center. The pregnant patient — Noelle — groans and moves as the doctors operate, trying to reposition the baby whose shoulder is lodged against the mother after the head has been delivered. The staff completes the procedure, delivering the baby, saving the mother and gaining experience about the situation in about 15 minutes — then the patients stop moving and are replaced back in their original, mechanical positions. The medical staff moves on to a debriefing about how they responded to the rare, but serious, case. Noelle is a obstetric simulator and the shoulder dystocia situation is the first of many HRMC Obstetrics Patient Care Manager Roxanne Kudrna hopes to bring to the department. “Simulation training offers visual, physiological and tactile realism that mimics the look and feel of performing the actual procedure,” Kudrna said. “They use their actual instruments, the anatomy looks real and responds. Virtual patients complain if they are hurt and may even exhibit bleeding during the procedure. We try to make it as lifelike as possible.” HRMC will begin offering simulations once a quarter, with a new topic every other quarter. Most of the simulations will involve low-occurance, high-risk procedures, Kudrna said. “This is nice because you don’t have to wait for a real-life opportunity to happen,” she said. Kudrna and another HRMC staff member, Sue Rembowski develop the scenario for each situation, and simulation participants are then given packets of information about each topic to prepare in advance, Kudrna said. “We talk about things like anticipated risks, what you’re going to look for in admittance, what to be prepared for if you have those risks and what to do if it occurs,” she said. “Then physicians sign up for a time slot and we explain the scenario. They do what they would normally do in that situation.” After the “operation,” the participants will have a debriefing about what went well, whether the right tools were available and what could have been improved, Kudrna said. “People really fall into the scenario and start believing it’s real,” she said. “We hope that in the future we can broaden this to include the other departments.” The shoulder dystocia scenario was chosen to help ease the participants into the idea. “It’s low fidelity,” Kudrna said. “Like if we had a postpartum hemorrhage, we’d have to have blood flow. This is the first one, and we wanted it to be a non-threatening environment” The simulation is available as part of HRMC’s alliances with the Northwest Physicians Insurance Company OB Collaborative/SimHealth Simulation Program through the Treasure Valley Community College Nursing Department, and Kudrna said the hospital also has plans to eventually include the nursing students into their simulations. TVCC does offer simulations at the school on multiple simulators for a variety of clinical scenarios, Kudrna said, but this is the first time the simulators will be used at the hospital. “We wanted to do it here because we wanted to troubleshoot for logistics, is all the equipment in the best place for that situation, and we wanted to make it as lifelike as possible,” she said. The hospital planned three drills Thursday and two Friday, and Noelle will go back to TVCC Monday. “Then we’ll repeat this same drill next quarter so all the folks who didn’t go through will have the opportunity. We’ll start a new one the quarter after that,” Kudrna said. “We’re striving to provide the best patient care possible.”