Labor & Delivery: Opportunity to Apply TeamSTEPPS Technique to Improve Outcome

Labor & Delivery: Opportunity to Apply TeamSTEPPS Technique to Improve Outcome


Jean Casey, RN: This is Michelle Keys. She’s a 27-year-old primigravida at 41 weeks. Her blood pressure was 135/70 on admission and her urine dipstick showed a trace for protein. Her cervix is 1 centimeter dilated, 25% effaced, and minus 3. Dr. Albert Dean: Her first blood pressure in the clinic today was 141/88; the repeat was normal. We’ll need to keep an eye on her blood pressures. She could be developing preeclampsia. Dr. Jim Pham: Let’s run a type and screen and a CBC. We need to check her liver functions and uric acid level. Dr. Upton wants to start her induction with Misoprostol intravaginally. I think that’s 100 micrograms, right? Yeah, that’s it, 100 micrograms. Dr. Dean: Janet, who’s coming in for you? Jean: Dana Collins. I’ll talk to her about patient handoff. Dana Collins, RN: Hi, Janet, how’re things looking tonight? Jean: Hi, Dana. I’m late to pick up my kids from the sitter, so I need to make this quick. We have a 27-year-old primigravida who’s had an uneventful pregnancy. She’s been admitted at 41 weeks for induction with an unfavorable cervix. Poor thing’s been waiting for a bed since early afternoon and just got admitted. Dana: That long, huh? How’s she doing, and who’s the attending? Jean: She’s stable right now. The attending is Dr. Upton. Nurse: We’re doing a stat section, room 15. I need your help moving the patient to the OR. Dana: Right. I’ll head over. Nothing but the usual, right? Jean: Right. Sorry, I’m in a rush. Dana: Dr. Pham, can you please look at this fetal heart rate tracing? We’re seeing late decelerations. Dr. Pham: She’s at 6. Dr. Dean. Do you think we should call Dr. Upton? Dr. Dean: No, I think we can handle this without him. Dana: Dr. Dean, it looks like these decelerations are getting even more severe. Dr. Pham: Dr. Dean, do you think we should consider a C-section? Dr. Dean: No. Not yet, anyway. This looks okay. Dana: Dr. Dean, the baby’s heart rate’s been in the 60s. Dr. Dean: Let’s continue to monitor. Dana: It’s been like this for three minutes. Dr. Dean: We need an emergency section. Get Dr. Upton in here, now! Dr. Upton: Albert, Jim, I can’t believe the two of you! How long have you been here? This baby nearly died. What were you thinking? There’s just no excuse for this.

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