678 Body shapes don’t define a patient, so why does it affect basic life support? An in-situ simulation scenario on choking for a child with an altered body shape

BACKGROUND The use of new technology like virtual reality, e-learning, and serious gaming can offer novel, more accessible options that have been demonstrated to improve learning outcomes. OBJECTIVE The aim of this study was to compare the educational effectiveness of serious game–based simulation training to traditional mannequin-based simulation training and to determine the perceptions of physicians and nurses. We used an obstetric use case, namely electronic fetal monitoring interpretation and decision making, for our assessment. METHODS This study utilized a mixed methods approach to evaluate the effectiveness of the new, serious game–based training method and assess participants’ perceptions of the training. Participants were randomized to traditional simulation training in a center with mannequins or serious game training. They then participated in an obstetrical in-situ simulation scenario to assess their learning. Participants also completed a posttraining perceptions questionnaire. RESULTS The primary outcome measure for this study was the participants’ performance in an in-situ mannequin-based simulation scenario, which occurred posttraining following a washout period. No significant statistical differences were detected between the mannequin-based and serious game–based groups in overall performance, although the study was not sufficiently powered to conclude noninferiority. The survey questions were tested for significant differences in participant perceptions of the educational method, but none were found. Qualitative participant feedback revealed important areas for improvement, with a focus on game realism. CONCLUSIONS The serious game training tool developed has potential utility in providing education to those without access to large simulation centers; however, further validation is needed to demonstrate if this tool is as effective as mannequin-based simulation. CLINICALTRIAL Not applicable.

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

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1856 ◽

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.

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Impact of In Situ Education on Management of Cardiac Arrest after Cardiac Surgery

Southwest Journal of Pulmonary and Critical Care ◽

10.13175/swjpcc028-21 ◽

2021 ◽

Vol 23 (2) ◽

pp. 54-61

Author(s):

Bhargavi Gali ◽

◽

Grace Arteaga ◽

Glen Au ◽

Vitaly Herasevich

Keyword(s):

Cardiac Arrest ◽

Cardiac Surgery ◽

Life Support ◽

Advanced Life Support ◽

Cardiac Massage ◽

Chest Compressions ◽

In Situ Simulation ◽

Before And After ◽

Initial Medication

Background: Advanced life support interventions have been modified for patients who have recently undergone sternotomy for cardiac surgery and have new suture lines. We aimed to determine whether the use of in-situ simulation increased adherence to the cardiac surgery unit-advanced life support algorithm (CSU-ALS) for patients with cardiac arrest after cardiac surgery (CAACS). Methods: This was a retrospective chart review of cardiac arrest management of patients who sustained CAACS before and after implementation of in-situ simulation scenarios utilizing CSU-ACLS in place of traditional advanced cardiac life support. We utilized classroom education of CSU-ACLS followed by in-situ high-fidelity simulated scenarios of patients with CAACS.. Interprofessional learners (n = 210) participated in 18 in-situ simulations of CAACS. Two groups of patients with CAACS were retrospectively compared before and after in situ training (preimplementation, n=22 vs postimplementation, n=38). Outcomes included adherence to CSU-ALS for resuscitation, delay in initiation of chest compressions, use of defibrillation and pacing before external cardiac massage, and time to initial medication. Results: Chest compressions were used less often in the postimplementation vs the preimplementation period (11/22 [29%] vs 13/38 [59%], P = 0.02). Time to initial medication administration, use of defibrillation and pacing, return to the operating room, and survival were similar between periods. Conclusion: In this pilot, adherence to a key component of the CSU-ALS algorithm—delaying initiation of chest compressions—improved

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Using In Situ Simulation to Develop a Prone Positioning Protocol for Patients With ARDS

Critical Care Nurse ◽

10.4037/ccn2020830 ◽

2020 ◽

pp. e1-e13

Author(s):

Jessica Montanaro

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Prone Positioning ◽

In Situ Simulation ◽

Training Video ◽

Simulation Scenario ◽

Initial Survey

Background Acute respiratory distress syndrome carries a 40% mortality rate. Prone positioning remains underused owing to clinicians’ low degree of confidence, concern about the risk of adverse outcomes, and lack of staff competency training. Local Problem and Purpose A prone positioning protocol and educational program were needed in an intensive care unit to achieve compliance with best practices for treating acute respiratory distress syndrome patients. Methods An initial survey was conducted to measure staff confidence and competency in prone positioning. A literature review was performed, and a plan-do-study-act approach was used to develop a protocol through in situ simulation involving mock patients. A training video and a simulation scenario using a high-fidelity manikin were developed to facilitate staff education. Staff were surveyed again after training. Interventions During the simulation scenario, interdisciplinary clinicians learned to apply the protocol and resupinate the patient during a simulated emergency. The training video was later used for “just in time” education minutes before actual prone positioning events. Results A total of 25 critical care nurses, 11 respiratory therapists, and 10 physicians completed the initial survey and simulation training. The survey showed that staff lacked confidence and competency in prone positioning. Staff demonstrated competence during the simulation sessions, and posttraining surveys indicated increased confidence. After the educational program, prone positioning was successfully used for 6 critically ill acute respiratory distress syndrome patients. Conclusions In situ simulation and interdisciplinary collaboration increase standardization of high-risk, underused procedures, improving staff confidence and competence as well as patient safety.

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Lessons Learned From an Evaluation of Serious Gaming as an Alternative to Mannequin-Based Simulation Technology: Randomized Controlled Trial

JMIR Serious Games ◽

10.2196/21123 ◽

2020 ◽

Vol 8 (3) ◽

pp. e21123

Author(s):

Natalie C Benda ◽

Kathryn M Kellogg ◽

Daniel J Hoffman ◽

Rollin J Fairbanks ◽

Tamika Auguste

Keyword(s):

Simulation Training ◽

Controlled Trial ◽

Lessons Learned ◽

Serious Game ◽

Educational Method ◽

Serious Gaming ◽

In Situ Simulation ◽

Training Tool ◽

Simulation Scenario

Background The use of new technology like virtual reality, e-learning, and serious gaming can offer novel, more accessible options that have been demonstrated to improve learning outcomes. Objective The aim of this study was to compare the educational effectiveness of serious game–based simulation training to traditional mannequin-based simulation training and to determine the perceptions of physicians and nurses. We used an obstetric use case, namely electronic fetal monitoring interpretation and decision making, for our assessment. Methods This study utilized a mixed methods approach to evaluate the effectiveness of the new, serious game–based training method and assess participants’ perceptions of the training. Participants were randomized to traditional simulation training in a center with mannequins or serious game training. They then participated in an obstetrical in-situ simulation scenario to assess their learning. Participants also completed a posttraining perceptions questionnaire. Results The primary outcome measure for this study was the participants’ performance in an in-situ mannequin-based simulation scenario, which occurred posttraining following a washout period. No significant statistical differences were detected between the mannequin-based and serious game–based groups in overall performance, although the study was not sufficiently powered to conclude noninferiority. The survey questions were tested for significant differences in participant perceptions of the educational method, but none were found. Qualitative participant feedback revealed important areas for improvement, with a focus on game realism. Conclusions The serious game training tool developed has potential utility in providing education to those without access to large simulation centers; however, further validation is needed to demonstrate if this tool is as effective as mannequin-based simulation.

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