Familiarity with the clinical environment, achieved by priming, improves time to antibiotic administration in a simulated paediatric sepsis scenario: a randomised control trial

2020 ◽  
pp. archdischild-2020-318904
Author(s):  
Ben McNaughten ◽  
Lesley Storey ◽  
Doris Corkin ◽  
Pauline Cardwell ◽  
Andrew Thompson ◽  
...  
Keyword(s):  
Nursing Students ◽  
Focus Groups ◽  
Student Performance ◽  
Clinical Performance ◽  
Randomised Control Trial ◽  
Antibiotic Administration ◽  
Clinical Environment ◽  
Early Administration ◽  
In Situ Simulation

AimThe early administration of antibiotics in sepsis reduces mortality and improves outcomes. This randomised control trial evaluated the effect of environmental priming (EP) on healthcare student performance in a simulated paediatric sepsis scenario.MethodsMedical and nursing students were randomised into primed and unprimed groups. Primed groups received both direct and virtual priming. Each group completed a standardised simulated sepsis scenario. Time to achieve five key clinical interventions was recorded. Mini focus groups were conducted to explore perceptions of EP.ResultsThere were 26 primed and 26 unprimed groups. The primed students were quicker to complete all five interventions and statistically significantly quicker to achieving intravenous (IV) access (median 350 s vs 373 s, p=0.02), administering IV antibiotics (median 648 s vs 760 s, p=0.045) and seeking senior help (median 703 s vs 780 s, p=0.02). Primed students did not feel that they had gained any specific advantage from being primed.ConclusionsEP can improve clinical performance. Implications for practice include incorporating EP of key clinical areas into local induction, standardisation of resuscitation areas and regular use of in situ simulation.

In-situ simulation for the detection of latent risk threats in a hyperbaric medicine department

2020 ◽  
Vol 47 (1) ◽  
Keyword(s):  
Care Delivery ◽  
Health Care Delivery System ◽  
Clinical Environment ◽  
Medicine Department ◽  
In Situ Simulation ◽  
Quality Improvement Process ◽  
Effective Manner ◽  
Hyperbaric Medicine

Simulation (SIM) can be used in the quality improvement process to discover latent risk threats (LRTs) by running in-situ simulation cases in the clinical environment. We utilized this methodology in the hyperbaric chamber to run six in-situ SIM sessions between February 2017 and January 2019. The debriefing portion of each SIM was used to discuss and document all discovered LRTs. These safety threats were aggregated and categorized, resulting in a total of 22 unique LRTs. LRTs included problems or challenges with equipment, team education, policy/processes, communications, and medications. At a three-month follow-up, the hyperbaric leadership team had addressed each of the 22 unique LRTs. SIM can be used to identify, categorize and prioritize LRTs in an effective manner, in order to improve the health care delivery system in a hyperbaric medicine department.

In Situ Simulation to Assess Pediatric Tracheostomy Care Safety: A Novel Multicenter Quality Improvement Program

2020 ◽  
Vol 163 (2) ◽  
pp. 250-258
Author(s):  
Sharan J. Shah ◽  
Cristen Cusumano ◽  
Sadia Ahmed ◽  
Anthony Ma ◽  
Farrukh N. Jafri ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Assessment Tool ◽  
Clinical Care ◽  
System Level ◽  
Clinical Environment ◽  
Improvement Program ◽  
In Situ Simulation ◽  
Simulation Performance ◽  
Tracheostomy Tubes

Objectives Our objectives were (1) to use in situ simulation to assess the clinical environment and identify latent safety threats (LSTs) related to the management of pediatric tracheostomy patients and (2) to analyze the effects of systems interventions and team factors on LSTs and simulation performance. Methods A multicenter, prospective study to assess LSTs related to pediatric tracheostomy care management was conducted in emergency departments (EDs) and intensive care units (ICUs). LSTs were identified through equipment checklists and in situ simulations via structured debriefs and blinded ratings of team performance. The research team and unit champions developed action plans with interventions to address each LST. Reassessment by equipment checklists and in situ simulations was repeated after 6 to 9 months. Results Forty-one LSTs were identified over 21 simulations, 24 in the preintervention group and 17 in the postintervention group. These included LSTs in access to equipment (ie, availability of suction catheters, lack of awareness of the location of tracheostomy tubes) and clinical knowledge gaps. Mean equipment checklist scores improved from 76% to 87%. Twenty-one unique teams (65 participants) participated in the simulations. The average simulation score was 6.19 out of 16 points. Discussion In situ simulation is feasible and effective as an assessment tool to identify latent safety threats and thus measure the system-level performance of a clinical care environment. Implications for Practice In situ simulation can be used to identify and reassess latent safety threats related to pediatric tracheostomy management and thereby support quality improvement and educational initiatives.

P1856KIDNEY CRISES: USING IN SITU SIMULATION TEACHING TO FACILITATE MULTIDISCIPLINARY TEAM WORKING IN RENAL EMERGENCIES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ailish Nimmo ◽  
Katie Adams
Keyword(s):  
Life Support ◽  
Clinical Skills ◽  
Junior Doctors ◽  
Clinical Environment ◽  
Dialysis Unit ◽  
In Situ Simulation ◽  
Team Working ◽  
Clinical Scenarios ◽  
Medical Emergencies

Abstract Background and Aims The haemodialysis unit is a unique clinical environment. Specialist nursing staff look after patients, frequently without on-site medical cover, and need to manage medical issues until help arrives. Junior doctors often have limited experience managing renal patients and may not be aware of specialty-specific issues when dealing with medical emergencies. The different skill sets in these groups creates an opportunity for shared learning. Simulation teaching provides a safe environment for individuals to develop communication, team working and clinical skills and helps facilitate discussion and reflection on clinical scenarios. We describe a programme of renal in situ simulation sessions for nurses and junior doctors to allow them to practise their roles in an emergency and evaluate feedback on their perception of the programme. Method Seventeen hour-long simulation sessions were delivered between June 2017 and January 2020 within the renal ward in 2 hospitals and in a satellite outpatient dialysis unit. They utilised a high-fidelity SimMan® mannequin. Scenarios were based on common or rare-but-serious medical emergencies (hyperkalaemic cardiac arrest, arrhythmia on dialysis, air embolism, major haemorrhage post-renal biopsy, line sepsis, hypertensive seizure, pulmonary oedema and drug-induced anaphylaxis). Sessions comprised an orientation to the mannequin, a clinical scenario and a debrief discussion. Doctors and nurses completed post-tutorial feedback exploring their thoughts on the programme. Results 59 healthcare professionals (40 doctors and 19 nurses) participated and completed post-event feedback. All attendees felt that sessions improved their knowledge and increased their confidence in managing similar scenarios in the future. They all felt they would be able to apply their learning to their day job. 86% of participants strongly agreed that the programme helped them develop stronger relationships with colleagues. In white-space boxes, individuals described the sessions as being helpful in developing communication, teamwork, leadership and delegation skills in addition to specific learning points for the individual scenarios. Sessions also identified practical issues, such as where to source medications or monitoring equipment, and led to the creation of an updated protocol folder and distribution of Advanced Life Support algorithms throughout the ward. Conclusion Nurses and junior doctors report increased confidence in managing medical emergencies in renal patients and improved relationships with colleagues following a simulation training programme. The programme promotes a learning culture within the unit. It provides an opportunity to discuss potentially serious situations and allows reflection on similar scenarios encountered within the ward and dialysis unit. Further work is needed to determine if in situ simulation teaching has an impact on patient outcome measures.

In situ simulation as a tool for patient safety: a systematic review identifying how it is used and its effectiveness

2015 ◽  
Vol 1 (3) ◽  
pp. 103-110 ◽  
Author(s):  
Graham Fent ◽  
James Blythe ◽  
Omer Farooq ◽  
Makani Purva
Keyword(s):  
Patient Safety ◽  
Clinical Skills ◽  
Real Life ◽  
Interdisciplinary Teams ◽  
Cochrane Library ◽  
Future Research ◽  
Clinical Environment ◽  
In Situ Simulation ◽  
Safety Outcomes

BackgroundIn situ simulation is an emerging technique involving interdisciplinary teams working through simulated scenarios which replicate events encountered in healthcare institutions, particularly those which are either low frequency or associated with high risk to patients. Since it takes place in the clinical environment, it is ideally suited to improving patient safety outcomes.ObjectiveTo identify and appraise all studies assessing contribution of in situ simulation to patient safety, identify gaps in knowledge and areas for future research, as well as suggesting strategies for maximising its impact on patient safety within an institution.Study selectionThree electronic databases (MEDLINE, PubMed and EMBASE) as well as the Cochrane Library were searched for articles relating to patient safety outcomes in in situ simulation. In addition a subject expert was approached to suggest any additional articles not identified by electronic searches. A total of 1795 abstracts were identified and screened, 35 full articles assessed for eligibility for inclusion and a total of 18 full articles included in the review after unsuitable articles were excluded.ConclusionsIn situ simulation can improve real-life patient safety outcomes, with 2 studies demonstrating improved morbidity and mortality outcomes following initiation of in situ simulation. There is good evidence to suggest that its implementation leads to improved clinical skills, teamwork and observed behaviours. Additionally, it is ideally suited to detecting latent safety errors (errors identified within a scenario which, if they had occurred in real life, could have led to a degree of harm occurring to a patient).

Latent safety threat identification during in situ simulation debriefing: a qualitative analysis

2020 ◽  
pp. bmjstel-2020-650
Author(s):  
Sparsh Shah ◽  
Melissa McGowan ◽  
Andrew Petrosoniak
Keyword(s):  
Resource Constraints ◽  
Qualitative Content Analysis ◽  
Physical Space ◽  
Trauma Centre ◽  
System Level ◽  
Clinical Environment ◽  
Text Data ◽  
In Situ Simulation ◽  
Safety Issues

BackgroundLatent safety threats (LSTs) in healthcare are hazards or conditions that risk patient safety but are not readily apparent without system stress. In situ simulation (ISS), followed by post-scenario debriefing is a common method to identify LSTs within the clinical environment. The function of post-ISS debriefing for LST identification is not well understood.ObjectivesThis study aims to qualitatively characterise the types of LSTs identified during ISS debriefing.MethodsWe conducted 12 ISS trauma scenarios followed by debriefing at a Canadian, Level 1 trauma centre. We designed the scenarios and debriefing for 15 and 20 min, respectively. Debriefings focused on LST identification, and each session was audio recorded and transcribed. We used an inductive approach with qualitative content analysis to code text data into an initial coding tree. We generated refined topics from the coded text data.ResultsWe identified five major topics: (1) communication and teamwork challenges, (2) system-level issues, (3) resource constraints, (4) positive team performance and (5) potential improvements to the current systems and processes.ConclusionsDuring simulation debriefing sessions for LST identification, participants discussed threats related to communication and interpersonal issues. Safety issues relating to equipment, processes and the physical space received less emphasis. These findings may guide health system leaders and simulation experts better understanding of the strengths and limitations of simulation debriefing for LST identification. Further studies are required to compare ISS-based LST identification techniques.

scholarly journals P112: In situ simulation: A team sport?

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S104
Author(s):  
D. Rusiecki ◽  
S. Hoffe ◽  
M. Walker ◽  
J. Reid ◽  
N. Rocca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Team Sport ◽  
Multidisciplinary Teams ◽  
Clinical Environment ◽  
Respiratory Therapist ◽  
In Situ Simulation ◽  
Kingston General Hospital ◽  
High Acuity ◽  
Survey Responses

Introduction: Identification of latent safety threats (LSTs) in the emergency department is an important aspect of quality improvement that can lead to improved patient care. In situ simulation (ISS) takes place in the real clinical environment and multidisciplinary teams can participate in diverse high acuity scenarios to identify LSTs. The purpose of this study is to examine the influence that the profession of the participant (i.e. physician, registered nurse, or respiratory therapist) has on the identification of LSTs during ISS. Methods: Six resuscitation- based adult and pediatric simulated scenarios were developed and delivered to multidisciplinary teams in the Kingston General Hospital ED. Each ISS session consisted of a 10- minute scenario, followed by 3-minutes of individual survey completion and a 7- minute group debrief led by ISS facilitators. An objective assessor recorded LSTs identified during each debrief. Surveys were completed prior to debrief to reduce response bias. Data was collected on participant demographics and perceived LSTs classified in the following categories: medication; equipment; resources and staffing; teamwork and communication; or other. Two reviewers evaluated survey responses and debrief notes to formulate a list of unique LSTs across scenarios and professions. The overall number and type of LSTs from surveys was identified and stratified by health care provider. Results: Thirteen ISS sessions were conducted with a total of 59 participants. Thirty- four unique LSTs (8 medication, 15 equipment, 5 resource, 4 communication, and 2 miscellaneous issues) were identified from surveys and debrief notes. Overall, MDs (n = 12) reported 19 LSTss (n = 41) reported 77 LSTs, and RTs (n = 6) reported 4 LSTs based on individual survey data. The most commonly identified category of LSTs reported by MDs (36.8%) and RTs (75%) was equipment issues while RNs most commonly identified medication issues (36.4%). Participants with □5 years of experience in their profession, on average identified more LSTs in surveys than participants with >5 years experience (1.9 LSTs vs 1.5 LSTs respectively). Conclusion: Nursing staff identified the highest number of LSTs across all categories. There was fairly unanimous identification of major LSTs across professions, however each profession did identify unique perspectives on LSTs in survey responses. ISS programs with the purpose of LST identification would benefit from multidisciplinary participation.

scholarly journals Å skape handlingsrom for pasientsikkerhet i sykehjem. Sykepleieres erfaringer med å delta i simulering in situ på sykehjem

2021 ◽  
pp. 177-198
Author(s):  
Sari Lindgren ◽  
Mona Lahm Høgbakk ◽  
Anne Svelstad Evju ◽  
Lena Wiklund Gustin
Keyword(s):  
Patient Safety ◽  
Nursing Homes ◽  
Early Stage ◽  
Qualitative Content Analysis ◽  
Learning Activity ◽  
Clinical Environment ◽  
In Situ Simulation ◽  
Simulation Based ◽  
Simulation Center

Some patients in nursing homes require extra attention to enable staff to detect and manage deterioration at an early stage. Nursing skills are vital to make systematic observations and assessments of a patient’s condition. It is challenging for nurses in nursing homes to make professional decisions without being able to consult other nurses. To improve the quality and safety of health care for patients and their relatives, the focus must be on working to ensure patient safety in nursing homes. Simulation-based learning can be one way to increase reflection on patient safety and develop health professionals’ knowledge, skills and attitudes, while protecting patients from unnecessary risks. Simulation-based learning as a method in medical education offers activities that mimic a clinical environment, where students can practice procedures and decision-making and where their critical thinking can be enhanced through role-play, videos or simulators. While simulation often takes place in a simulation center, in situ simulation refers to a learning activity that takes place in participants’ everyday work environment where they actually provide patient care. In this chapter, we aim to describe nurses’ experiences of in situ simulation and their subsequent reflections on patient safety in nursing homes. Data were collected from two focus groups with 5–6 nurses per group. The transcribed material was analyzed using qualitative content analysis, and two categories were identified that described the nurses’ experiences: “to doubt oneself” and “being dependent on others”.

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