Unit readiness
The statement is explicit that a sample checklist becomes useful only after a facility adapts it, sites it, drills it and measures it. These are its own implementation steps, made countable.
Implementation steps (SMFM 2026, Suggestions for Implementation; methodology refs 16, 17)
0%Assemble a multidisciplinary team to adapt the checklist to this facility
Obstetrical providers (generalists, hospitalists, MFM), obstetrical anesthesia, L&D nursing leadership and staff, medicine subspecialists (cardiology, pulmonary, critical care), and representatives of the blood bank, pharmacy, rapid response team and emergency department. Each stakeholder group should have at least one member.
SMFM 2026 §3Detail
Decide where the checklist is kept, and confirm it is reachable from all four rooms
Labour room, delivery room, operating room, post-anesthesia recovery unit. A pocket on the crash cart or hemorrhage cart, or a computerized system genuinely accessible in seconds.
SMFM 2026 §3Detail
Pilot test through simulated scenarios; revise; pilot again
The statement asks for a second pilot after revision, not one.
SMFM 2026 §3Detail
Introduce it broadly — in-service training, grand rounds, departmental meetings, board reports, change-of-shift huddles
SMFM 2026 §3
Run AFE simulations and drills so staff know where it is and how to use it
SMFM 2026 §3
Conduct a sentinel event analysis after every AFE case
SMFM 2026 §3
Define institutional performance measures
Proportion of suspected AFE events in which the checklist is initiated and documented; time from recognition to CPR initiation and to cesarean delivery; mean documentation time during codes before versus after implementation.
SMFM 2026 §3Detail
Where to keep it
Almost all AFE cases occur in the labour room, delivery room, operating room or post-anesthesia recovery unit. The statement suggests a pocket on the side of the crash cart or hemorrhage cart, and notes that units with a readily accessible computerized system may keep it there instead. That second option is the one this tool is built for — but only if it is genuinely reachable in seconds from every one of those four rooms, and only if that has been tested during a drill rather than assumed.
A readiness item the statement does not list
Ask, during the next drill, what the team would do if the woman developed sudden uterine hypertonus with fetal bradycardia. If anyone reaches for terbutaline, the unit has a teaching problem that the checklist will not fix. See hyperstimulation.