Implementing a Checklist & Hourly Huddles to Increase Situational Awareness During the Second Stage of Labor-A Perinatal Quality Improvement Project

Background: Current management of the second stage of labor often follows tradition-based routines rather than evidence-based practices. A lack of situational awareness and tunnel vision can limit medical decision-making. Northern New England Perinatal Quality Improvement Network (NNEPQIN) has listed Second Stage Situational Awareness as a priority initiative. Standardized checklists are useful for maintaining situational awareness. Regular debriefings using a standardized tool have been shown to improve communication and team based care, which generally leads to improved patient outcomes. Based on this evidence, developing a standardized checklist including regular hourly care team “huddles” is valuable and could result in improved birth outcomes. AIM Statement: The global aim of this project was to reduce variability in practice during the second stage of labor to improve neonatal birth outcomes. The specific aim was to implement a second stage situational awareness checklist with a completion percentage of 80% by July 2015. Method: The theoretical framework guiding this project was Endsley’s theory of Situation Awareness. Pre-implementation chart reviews were conducted to determine what information was currently being documented during the second stage. A 9-item checklist was developed based on hospital preference for use during hourly huddles once second stage was reached. Staff were educated on checklist use pre-implementation. Post-implementation chart reviews were conducted to determine checklist completion percentage. Results: Chart reviews demonstrated an average checklist completion percentage of 43% over the two-week implementation period with a range of 22-89%. Huddles were conducted and documented in 33% of the reviewed delivery charts. Conclusions: Continued follow up and work re-design is needed to consistently incorporate the checklist and huddles into practice. Implications for the CNL: Implications for the CNL include continuing staff education to increase awareness and acceptance of the practice change, and examining project effects on perinatal outcomes including delivery mode and neonatal Apgar scoring