A Simple Low-Cost Method to Integrate Telehealth Interprofessional Team Members During In Situ Simulation

Introduction: Our hospital faced an uphill battle with increasing clinical emergencies, a surge of patients, and compliance with the new regulations during the COVID-19 pandemic. Thereby, the code blue team developed a protected code blue protocol to minimize the infectious risk of the code team members and provide efficient management of emergencies during a lifesaving situation. Objectives: This project aimed to help the core team members to practice the new protected code blue protocol using in-situ simulation. The drills might improve the self-confidence of the code team members in performing their role, clear identification of themselves, effective communication skills, and teamwork. Methods: The mock code team developed different scenarios and ran the drills in 17 departments in different shifts within 8 weeks. A convenience sample of 269 staff participated in the drills. Participants included physicians, respiratory therapists, nurses, and other disciplinary staff. A debriefing was conducted to identify areas of improvement. Participants completed an evaluation form during the debriefing. The form included questions using a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) to rate the variables. Descriptive statistics and the Pearson correlation coefficient were used to test the hypotheses. Results: Out of the 269 participants, 125 staff completed and returned the evaluation form. The mean overall rating of the protected mock codes was 4.184 at a scale from 1 (very poor) to 5 (excellent) with a standard deviation of .827. The Pearson correlation coefficient ( r ) between the overall rating of the training and the amount of self-confidence in performing their role was .697 ( p =.000); clear identification of themselves was .329 ( p = .000); effective communication skills was .500 ( p = .000); and teamwork was .526 ( p = .000). Limitations: The project was conducted in a teaching hospital. The results might not apply to different care delivery settings. Conclusions: The findings of this project demonstrated that in-situ simulation improved the self-confidence of the code team members, communication skills, and teamwork in performing the protected code blue protocol for a COVID-19 suspected or confirmed patient with cardiac arrest.

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Multiprofessional in situ simulation is an effective method of identifying latent patient safety threats on the gastroenterology ward

Frontline Gastroenterology ◽

10.1136/flgastro-2019-101307 ◽

2020 ◽

Vol 11 (5) ◽

pp. 351-357 ◽

Cited By ~ 1

Author(s):

Elizabeth Uttley ◽

Deborah Suggitt ◽

David Baxter ◽

Wisam Jafar

Keyword(s):

Patient Safety ◽

Action Plan ◽

Gastrointestinal Haemorrhage ◽

Primary Objective ◽

Multiprofessional Team ◽

In Situ Simulation ◽

Team Members ◽

Biliary Sepsis ◽

Emergency Scenarios

ObjectiveIn situ simulation (ISS) is an effective training method for multiprofessional teams dealing with emergencies in high pressured environments. A regular ISS programme was organised for the multiprofessional gastroenterology team with a primary objective of identifying, classifying and addressing latent patient safety threats and secondary objectives of improving team confidence and individual role recognition.Method22 unannounced ISS sessions (averaging approximately one session every 6 weeks and four participants per session) were conducted between February 2017 and August 2019 involving multiprofessional team members. The sessions centred around the following four common gastrointestinal emergency scenarios: massive upper gastrointestinal haemorrhage; biliary sepsis (cholangitis) and shock; postendoscopic retrograde cholangiopancreatography complications including perforation and cardiac arrest. Following the simulation, the faculty, which included nurses and doctors, facilitated a structured debrief session and action plan to identify and address latent errors.Results96 participants from nursing, medical, physician associate and pharmacy backgrounds took part in the simulation programme. Analysis of collected latent safety threats identified the following four themes: education and training; equipment; medication and team working. Analysis of anonymously completed questionnaires identified that 95% of participants had a perceived better understanding of their role and 86% felt more confident in assessing an unwell patient. 96% of participants felt comfortable during the debrief.ConclusionISS provides a unique opportunity to train the multiprofessional gastroenterology team in their own high-pressured environment, helping identify and address latent patient safety threats and improve perceived participant confidence and role recognition.

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P004: Simulation for emergency department quality improvement

CJEM ◽

10.1017/cem.2018.202 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S58-S58

Author(s):

J. B. Baylis ◽

J. Slinn ◽

K. Clark

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Simulation Program ◽

Quality Improvement Initiative ◽

Team Communication ◽

In Situ Simulation ◽

Team Members ◽

Action Item ◽

Simulation Session

Introduction: There have been an increasing number of studies published since 2011 investigating the benefits of in situ simulation as a quality improvement (QI) modality. We instituted an emergency department (ED) in situ simulation program at Kelowna General Hospital in 2015 with the aims of improving inter-professional collaboration, improving team communication, developing resident resuscitation leadership skills, educating ED professionals on resuscitation medical expertise, and identifying QI action items from each simulation session. Methods: We applied the SMART framework. Our specific, measureable, and attainable goal was to select two QI action items discovered from each simulation session. Realistic and timely follow-up on each action item was conducted by the nurse educator group who reported back to the local ED network, pharmacy, or manager depending on the action item. This ensured sustainability of our model. Results: A total of 65 individuals participated in 2015 at program inception. This increased to 213 individuals in 2017 with an average of 24 participants/session. Attendants included nurses (31%), ED physicians (20%), ED residents (18%), paramedics (10%), and medical students, respiratory therapists, pharmacists, and others (21%). Our QI action items were grouped as (1) team/communication, (2) equipment/resources, and (3) knowledge/tasks. Examples of each category were: (1) Inability to hear paramedic bedside reports resulting in reinforcement of one paramedic speaking while the team remains quiet, (2) Difficulty in looking up medication information in the resuscitation bay resulting in installation of an additional computer in the resuscitation bay, and (3) Uncertainty of local process for initiating extra corporeal membrane oxygenation (ECMO) in the ED resulting in review of team placement, patient transfer, and initiation of ECMO lines in the ED. Inter-professional team members have reported through electronic feedback on the value of these sessions, including improved inter agency cooperation and understanding. Conclusion: This quality improvement initiative used in situ simulation as a QI tool. We were able to identify latent safety threats, test new patient care protocols, find equipment issues, and foster teamwork in a sustainable way to improve the quality of care in our ED. We hope that this serves as encouragement to others who are initiating a similar program. Our main suggestions after reflection include: (1) Engage a multidisciplinary team in the development of an in situ simulation program, (2) Start with aims and objectives, (3) Foster attendance and buy in by making it convenient for people to attend, (4) Celebrate your successes through interdepartmental communication, and (5) Recruit individuals with expertise in simulation based education.

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To Eliminate Curtain Effect of FIB TEM Samples by a Combination of Sample Dicing and Backside Milling

ISTFA 2014: Conference Proceedings from the 40th International Symposium for Testing and Failure Analysis ◽

10.31399/asm.cp.istfa2014p0400 ◽

2014 ◽

Author(s):

Jian-Shing Luo ◽

Hsiu Ting Lee

Keyword(s):

Sample Preparation ◽

Focused Ion Beam ◽

Preparation Method ◽

Low Cost ◽

Ion Beam ◽

Sample Preparation Method ◽

Site Specific ◽

Dual Beam ◽

Transmission Electron

Abstract Several methods are used to invert samples 180 deg in a dual beam focused ion beam (FIB) system for backside milling by a specific in-situ lift out system or stages. However, most of those methods occupied too much time on FIB systems or requires a specific in-situ lift out system. This paper provides a novel transmission electron microscopy (TEM) sample preparation method to eliminate the curtain effect completely by a combination of backside milling and sample dicing with low cost and less FIB time. The procedures of the TEM pre-thinned sample preparation method using a combination of sample dicing and backside milling are described step by step. From the analysis results, the method has applied successfully to eliminate the curtain effect of dual beam FIB TEM samples for both random and site specific addresses.

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Using In-Situ Simulation for Extracorporeal Cardiopulmonary Resuscitation (ECPR) Guideline Development.

SSRN Electronic Journal ◽

10.2139/ssrn.3409806 ◽

2019 ◽

Cited By ~ 1

Author(s):

Paul Ross ◽

Chris Nickson ◽

Jayne Sheldrake ◽

Jason McClure

Keyword(s):

Cardiopulmonary Resuscitation ◽

Guideline Development ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

In Situ Simulation

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Feasibility study of technology-enabled prevention intervention for children and families (Preprint)

10.2196/preprints.14029 ◽

2019 ◽

Author(s):

Nikki Theofanopoulou ◽

Katherine Isbister ◽

Julian Edbrooke-Childs ◽

Petr Slovák

Keyword(s):

Emotion Regulation ◽

Pilot Study ◽

Low Cost ◽

Digital Camera ◽

Well Being ◽

Structured Interview ◽

Object A ◽

Intervention Delivery ◽

Parents And Children

BACKGROUND A common challenge within psychiatry and prevention science more broadly is the lack of effective, engaging, and scale-able mechanisms to deliver psycho-social interventions for children, especially beyond in-person therapeutic or school-based contexts. Although digital technology has the potential to address these issues, existing research on technology-enabled interventions for families remains limited. OBJECTIVE The aim of this pilot study was to examine the feasibility of in-situ deployments of a low-cost, bespoke prototype, which has been designed to support children’s in-the-moment emotion regulation efforts. This prototype instantiates a novel intervention model that aims to address the existing limitations by delivering the intervention through an interactive object (a ‘smart toy’) sent home with the child, without any prior training necessary for either the child or their carer. This pilot study examined (i) engagement and acceptability of the device in the homes during 1 week deployments; and (ii) qualitative indicators of emotion regulation effects, as reported by parents and children. METHODS In this qualitative study, ten families (altogether 11 children aged 6-10 years) were recruited from three under-privileged communities in the UK. The RA visited participants in their homes to give children the ‘smart toy’ and conduct a semi-structured interview with at least one parent from each family. Children were given the prototype, a discovery book, and a simple digital camera to keep at home for 7-8 days, after which we interviewed each child and their parent about their experience. Thematic analysis guided the identification and organisation of common themes and patterns across the dataset. In addition, the prototypes automatically logged every interaction with the toy throughout the week-long deployments. RESULTS Across all 10 families, parents and children reported that the ‘smart toy’ was incorporated into children’s emotion regulation practices and engaged with naturally in moments children wanted to relax or calm down. Data suggests that children interacted with the toy throughout the duration of the deployment, found the experience enjoyable, and all requested to keep the toy longer. Child emotional connection to the toy—caring for its ‘well-being’—appears to have driven this strong engagement. Parents reported satisfaction with and acceptability of the toy. CONCLUSIONS This is the first known study investigation of the use of object-enabled intervention delivery to support emotion regulation in-situ. The strong engagement and qualitative indications of effects are promising – children were able to use the prototype without any training and incorporated it into their emotion regulation practices during daily challenges. Future work is needed to extend this indicative data with efficacy studies examining the psychological efficacy of the proposed intervention. More broadly, our findings suggest the potential of a technology-enabled shift in how prevention interventions are designed and delivered: empowering children and parents through ‘child-led, situated interventions’, where participants learn through actionable support directly within family life, as opposed to didactic in-person workshops and a subsequent skills application.

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USING LOW-COST, IN SITU MEASUREMENTS OF OPTICAL BRIGHTENERS TO IDENTIFY WASTEWATER INPUTS TO STREAMS

10.1130/abs/2020am-352046 ◽

2020 ◽

Author(s):

Carly Finegan ◽

◽

Elizabeth Hasenmueller

Keyword(s):

Low Cost ◽

In Situ Measurements ◽

Optical Brighteners

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IMPROVING SYSTEM READINESS, STAFF PREPAREDNESS AND PATIENT SAFETY IN A NEW SINGLE FAMILY ROOM NICU THROUGH IN SITU SIMULATION

Paediatrics & Child Health ◽

10.1093/pch/pxy054.042 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e16-e16

Author(s):

Ahmed Moussa ◽

Audrey Larone-Juneau ◽

Laura Fazilleau ◽

Marie-Eve Rochon ◽

Justine Giroux ◽

...

Keyword(s):

Patient Safety ◽

Repeated Measures ◽

Large Scale ◽

Multidisciplinary Teams ◽

Single Family ◽

In Situ Simulation ◽

Ensure Patient Safety ◽

System Readiness ◽

Dependent Samples

Abstract BACKGROUND Transitions to new healthcare environments can negatively impact patient care and threaten patient safety. Immersive in situ simulation conducted in newly constructed single family room (SFR) Neonatal Intensive Care Units (NICUs) prior to occupancy, has been shown to be effective in testing new environments and identifying latent safety threats (LSTs). These simulations overlay human factors to identify LSTs as new and existing process and systems are implemented in the new environment OBJECTIVES We aimed to demonstrate that large-scale, immersive, in situ simulation prior to the transition to a new SFR NICU improves: 1) systems readiness, 2) staff preparedness, 3) patient safety, 4) staff comfort with simulation, and 5) staff attitude towards culture change. DESIGN/METHODS Multidisciplinary teams of neonatal healthcare providers (HCP) and parents of former NICU patients participated in large-scale, immersive in-situ simulations conducted in the new NICU prior to occupancy. One eighth of the NICU was outfitted with equipment and mannequins and staff performed in their native roles. Multidisciplinary debriefings, which included parents, were conducted immediately after simulations to identify LSTs. Through an iterative process issues were resolved and additional simulations conducted. Debriefings were documented and debriefing transcripts transcribed and LSTs classified using qualitative methods. To assess systems readiness and staff preparedness for transition into the new NICU, HCPs completed surveys prior to transition, post-simulation and post-transition. Systems readiness and staff preparedness were rated on a 5-point Likert scale. Average survey responses were analyzed using dependent samples t-tests and repeated measures ANOVAs. RESULTS One hundred eight HCPs and 24 parents participated in six half-day simulation sessions. A total of 75 LSTs were identified and were categorized into eight themes: 1) work organization, 2) orientation and parent wayfinding, 3) communication devices/systems, 4) nursing and resuscitation equipment, 5) ergonomics, 6) parent comfort; 7) work processes, and 8) interdepartmental interactions. Prior to the transition to the new NICU, 76% of the LSTs were resolved. Survey response rate was 31%, 16%, 7% for baseline, post-simulation and post-move surveys, respectively. System readiness at baseline was 1.3/5,. Post-simulation systems readiness was 3.5/5 (p = 0.0001) and post-transition was 3.9/5 (p = 0.02). Staff preparedness at baseline was 1.4/5. Staff preparedness post-simulation was 3.3/5 (p = 0.006) and post-transition was 3.9/5 (p = 0.03). CONCLUSION Large-scale, immersive in situ simulation is a feasible and effective methodology for identifying LSTs, improving systems readiness and staff preparedness in a new SFR NICU prior to occupancy. However, to optimize patient safety, identified LSTs must be mitigated prior to occupancy. Coordinating large-scale simulations is worth the time and cost investment necessary to optimize systems and ensure patient safety prior to transition to a new SFR NICU.

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