Obstetric Sepsis: Focus on the 3-Hour Bundle.

Early recognition and treatment of sepsis are key to decreasing maternal and fetal morbidity and mortality. Timing is critical, and early intervention is associated with improved outcomes. The perinatal provider is in a unique position to identify risk factors, perform assessments, and implement the first 3 hours of the sepsis bundle. Early detection and management combined with careful assessment can assist in providing evidence-based care and moving the patient to a higher level of care when warranted.

Nursing department orientation: are we missing the mark?

Hospitals routinely provide orientation for the new nurses they hire. The evolution of nursing practice is not reflected in the current teaching methods of nursing orientation. The authors examine the past 60 years of nursing department orientation and assert the need to move toward more effective and innovative teaching strategies.

Simulation-based training: the future of competency?

Traditionally, continuing education has focused on cognitive skills and technical skills, namely, what the provider needs to know and what the provider needs to be able to do. Successful completion of such education programs has conferred some degree of competence on the learner. For the most part, continuing education has been performed in silos with each healthcare provider discipline developing a program designed to meet the needs of their group. The Institute of Medicine and the Joint Commission have issued reports addressing patient safety, morbidity, and mortality of the newborn infant and maternal mortality, respectively. These reports call for the education of healthcare providers to include multidisciplinary team training and/or drills. Simulation-based training (SBT) is a methodology of education that is uniquely able to address cognitive and technical skills as well as behavioral skills and is ideal for multidisciplinary team training. As a result, SBT is beginning to be adopted in healthcare education. However, the following questions remain: Is a dedicated simulation space necessary, how should SBT be incorporated into the existing education program, and will it confer competency?

Debriefing in simulated-based learning: facilitating a reflective discussion.

The topic of debriefing has received little attention in the simulation literature. In simulation, knowing how to debrief the learner's experiences is as essential as creating scenarios and selecting the correct manikin. The purpose of this article will be to discuss debriefing as it relates to simulation-based learning. Aspects of simulation-based learning, including briefing (preparing learners for simulation) and the simulation (scenario), will be reviewed because they have particular relevance to debriefing. Guidelines and strategies for debriefing will be discussed to facilitate the learner's ability to reflect on their performance. Debriefing will be reviewed following 3 occasions: a critical patient event, an in situ drill, and a simulation at a simulation center. Since debriefing may be different in each of these instances, customizing debriefing to fit the learning environment will be examined. Finally, because of the significance of debriefing on learning, evaluation of the debriefer will be addressed to ensure optimal performance.

Making the move: from traditional neonatal education to simulation-based training.

Resuscitating neonates is a critical skill set for obstetric and neonatal care providers. The principles, knowledge, and skills of neonatal resuscitation as developed by the Neonatal Resuscitation Program are taught in a variety of ways to enhance learning including didactic, CD-ROM, hands-on-task training, and mock codes. Despite this variety of educational methods, studies have called into question the ability of the care provider to adequately perform neonatal resuscitation. Simulation-based training is gaining more recognition in healthcare as a method of training that incorporates adult learning theory, real-time clinical situations, and video debriefing of the scenario to allow a healthcare team an opportunity to practice skills and evaluate their performance. The Neonatal Resuscitation Program is including simulation-based training as an educational methodology to promote skill acquisition and performance enhancement in its providers.

Cardiac disease in pregnancy.

Cardiac disease complicates approximately 1% to 3% of pregnancies and is responsible for 10% to 15% of maternal mortality. The number of women of childbearing age with congenital disease is increasing as advances in diagnosis and treatment improve survival rates and overall health, allowing successful pregnancy. Pregnant women with severe cardiac disease or women who experience a cardiac event during pregnancy will require admission and stabilization in an adult critical care unit. This group of patients can prove challenging for the obstetrical staff and the critical care staff because they require blending of the knowledge and skills of 2 highly specialized areas of healthcare. The key component to a comprehensive and organized approach to management that ensures the best possible outcome for the woman is a multidisciplinary team that devises a plan on the basis of the most current information, communicates with each other and the patient effectively, and assumes responsibility for implementation of the plan. The purpose of this article is to review management of the woman with cardiac disease throughout pregnancy.