Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.32
Sebastian Brown, M. Nash
Introduction During the emergence of the Covid-19 pandemic, our tertiary maternity hospital was rapidly preparing strategies to manage expected dramatic changes to practice. One of the most complex medical emergencies is the ‘Category 1’ Emergency Caesarean Section, which requires a multitude of professional teams (midwives, obstetricians, anaesthetists and theatre teams, and neonatologists). A preterm delivery of a Covid-19-positive woman could increase risks to not only to mother and baby, but also staff members. We looked at using Human Factors methodology in anticipatory planning. FMEA (Failure Modes and Effects Analysis) was an attractive tool for a novel challenge, as it uses an expert team-based approach to consider a process to mitigate potential risk.1 FMEA has been used across medical specialties, with evidence supporting harm-reduction (including in NICU therapeutics2 3), as well as in identifying potential risk in obstetric emergencies, using simulated scenarios [4]. Methods We created a standard pre-term, Category 1 Emergency Section (under General Anaesthetic) scenario. To ensure maximal learning and relevance, we engaged senior members of all key specialities, by first running a ‘walk-through’ pre-simulation brief where we followed the patient journey from hospital entrance to recovery/neonatal unit. Once we had considered tentative new-style pathways within our teams, we ran a formal high-fidelity in-situ simulation, with volunteers for all staff roles, as well as a senior representative from each speciality to observe each stage. Following on from the simulation, the volunteer actors were summarily debriefed by their individual specialty leads, who then attended a post-simulation cross-specialty meeting to discuss the simulation chronologically, where we identified potential challenges or barriers to the ideal running of a future scenario. Outcomes This debrief formed the basis of the putative, streamlined, FMEA. Using discussion and analysis of raised issues, estimate RPNs (Risk Prioritisation Numbers) were calculated to allow a hierarchy of problems by combining risk of occurrence, likelihood of detection and severity. Expert opinions identified strategies to improve critical systems processes. Being aware of ‘Covid-19 information overload’ we carefully disseminated department-relevant key learning points, updated trust SOPs (Standard Operating Procedures), and developed Human Factors-based tools, such as pre-made equipment boxes, checklists and visual guides (eg. PPE posters/videos). Small-group in-situ simulation teaching was used to embed new practices. Conclusion This highlights the critical role of in-situ simulation for stress-testing hospital systems for novel challenges, and how to combine established Human Factors methods, such as FMEA, to maximise future patient safety.
在2019冠状病毒病大流行期间，我们的三级妇产医院正在迅速制定战略，以应对预期的巨大变化。最复杂的医疗紧急情况之一是“第一类”紧急剖腹产，它需要众多专业团队(助产士、产科医生、麻醉师和手术室团队以及新生儿专家)。一名covid -19阳性妇女的早产不仅会增加母亲和婴儿的风险，还会增加工作人员的风险。我们研究了在预期计划中使用人为因素方法。失效模式和影响分析(Failure Modes and Effects Analysis, FMEA)是一种有吸引力的工具，可以应对新的挑战，因为它使用基于专家团队的方法来考虑一个过程，以降低潜在风险FMEA已被用于医学专业，有证据支持减少伤害(包括新生儿重症监护室治疗s2 3)，以及通过模拟场景识别产科急诊的潜在风险[4]。方法:我们创建了一个标准的早产，第一类急诊科(全身麻醉下)的场景。为了确保最大程度的学习和相关性，我们聘请了所有关键专业的高级成员，首先进行了“演练”预模拟简报，我们跟踪了患者从医院入口到康复/新生儿病房的旅程。一旦我们在我们的团队中考虑了尝试性的新型路径，我们就运行了一个正式的高保真的现场模拟，所有员工角色都有志愿者，每个专业的高级代表都来观察每个阶段。在模拟之后，志愿者演员由他们各自的专业领导简要汇报，然后他们参加了模拟后的跨专业会议，按时间顺序讨论模拟，在那里我们确定了未来场景理想运行的潜在挑战或障碍。结果:这次汇报形成了假定的、简化的FMEA的基础。通过对提出问题的讨论和分析，估算rpn(风险优先级编号)被计算出来，通过结合发生风险、检测可能性和严重程度来允许问题的层次结构。专家意见确定了改进关键系统流程的策略。意识到“Covid-19信息超载”，我们认真传播了与部门相关的关键学习要点，更新了信任标准操作程序(sop)，并开发了基于人为因素的工具，如预制设备盒、清单和可视化指南(例如:PPE海报/视频)。采用小组现场模拟教学嵌入新实践。这突出了原位模拟在医院系统压力测试中的关键作用，以及如何结合既定的人为因素方法，如FMEA，以最大限度地提高未来患者的安全。
{"title":"PP13 Utilising in-situ simulation and failure modes and effects analysis techniques to prepare a maternity hospital and neonatal intensive care unit for preterm delivery via emergency caesarean section in a pregnant woman with suspected covid-19","authors":"Sebastian Brown, M. Nash","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.32","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.32","url":null,"abstract":"Introduction During the emergence of the Covid-19 pandemic, our tertiary maternity hospital was rapidly preparing strategies to manage expected dramatic changes to practice. One of the most complex medical emergencies is the ‘Category 1’ Emergency Caesarean Section, which requires a multitude of professional teams (midwives, obstetricians, anaesthetists and theatre teams, and neonatologists). A preterm delivery of a Covid-19-positive woman could increase risks to not only to mother and baby, but also staff members. We looked at using Human Factors methodology in anticipatory planning. FMEA (Failure Modes and Effects Analysis) was an attractive tool for a novel challenge, as it uses an expert team-based approach to consider a process to mitigate potential risk.1 FMEA has been used across medical specialties, with evidence supporting harm-reduction (including in NICU therapeutics2 3), as well as in identifying potential risk in obstetric emergencies, using simulated scenarios [4]. Methods We created a standard pre-term, Category 1 Emergency Section (under General Anaesthetic) scenario. To ensure maximal learning and relevance, we engaged senior members of all key specialities, by first running a ‘walk-through’ pre-simulation brief where we followed the patient journey from hospital entrance to recovery/neonatal unit. Once we had considered tentative new-style pathways within our teams, we ran a formal high-fidelity in-situ simulation, with volunteers for all staff roles, as well as a senior representative from each speciality to observe each stage. Following on from the simulation, the volunteer actors were summarily debriefed by their individual specialty leads, who then attended a post-simulation cross-specialty meeting to discuss the simulation chronologically, where we identified potential challenges or barriers to the ideal running of a future scenario. Outcomes This debrief formed the basis of the putative, streamlined, FMEA. Using discussion and analysis of raised issues, estimate RPNs (Risk Prioritisation Numbers) were calculated to allow a hierarchy of problems by combining risk of occurrence, likelihood of detection and severity. Expert opinions identified strategies to improve critical systems processes. Being aware of ‘Covid-19 information overload’ we carefully disseminated department-relevant key learning points, updated trust SOPs (Standard Operating Procedures), and developed Human Factors-based tools, such as pre-made equipment boxes, checklists and visual guides (eg. PPE posters/videos). Small-group in-situ simulation teaching was used to embed new practices. Conclusion This highlights the critical role of in-situ simulation for stress-testing hospital systems for novel challenges, and how to combine established Human Factors methods, such as FMEA, to maximise future patient safety.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80498015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.133
D. Wise, Ciaran Walsh, Tobias Chanin, R. Downey, Timothy Parr, S. Mercer
Background The novel coronavirus pandemic has the potential to cause significant morbidity in the United Kingdom with the risk of demand for hospital bed capacity significantly outstripping supply.1World Health Organisation guidance suggests that up-skill of non-acute medical and dental practitioners for rapid re-deployment into the acute medical environment is a vital task in ensuring appropriate surge capacity resilience.2 We report an ‘upskilling’ course at our institution. Summary of work A two-day course containing four key components was provided to pre-redeployment candidates. Day 1: Classroom–based teaching introducing COVID–19, infection prevention control and personal protective equipment use. Intermediate life support tutorials and low–fidelity simulation of a deteriorating patient. Day 2: Practical clinical skills session refreshers including venepuncture, cannulation, catheterisation, and arterial blood gas sampling. Followed by an opportunity to practice in a series of fully immersive high fidelity acute clinical scenarios proceeded by hot video–assisted debrief. Candidates completed pre and post course questionnaires. A follow up post course questionnaire will be sent out one-month post course. Unpaired (two tail) t-test analysis was used to analyse participant confidence scores pre and post course. Thematic analysis of qualitative feedback was also performed. Summary of Results Eighty-five candidates undertook the course with 76 (89%) completing pre & post questionnaires. Significant increases in candidate reported confidence were reported in; assessment of acutely unwell patients, leading a clinical team in the context of an acutely deteriorating patient and in handing over acutely unwell patients to senior acute clinicians. Candidates also reported significant confidence score increases regarding non-technical skills such as clinical decision making, demonstration of situational awareness, task management and team working. Participant qualitative feedback suggested three main advantages of the course: Simulation useful to tie up key skills learnt and to put skills into context, practical skills sessions useful refresher of common ward based activities, overall the faculty were enthusiastic and engaging and helped candidates to get the most out of the course. Discussion and Conclusions Our two-day multifaceted course provided non-acute medical and dental practitioners with significantly improved self-reported confidence in a number of key technical and non-technical domains. Clinical decision making and assessment of the deteriorating patient are critical for the maintenance of patient safety in the acute medical environment, in the context of medical human resource planning for a global pandemic. We hope that this course complemented ward based experiential learning at the start of the pandemic. References Imperial College London. Strengthening hospital capacity for the COVID-19pandemic. Available at: https://www.imperial.ac.uk/
{"title":"PG85 Up-skilling the workforce. Preparing to return to frontline medicine in the support of COVID-19","authors":"D. Wise, Ciaran Walsh, Tobias Chanin, R. Downey, Timothy Parr, S. Mercer","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.133","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.133","url":null,"abstract":"Background The novel coronavirus pandemic has the potential to cause significant morbidity in the United Kingdom with the risk of demand for hospital bed capacity significantly outstripping supply.1World Health Organisation guidance suggests that up-skill of non-acute medical and dental practitioners for rapid re-deployment into the acute medical environment is a vital task in ensuring appropriate surge capacity resilience.2 We report an ‘upskilling’ course at our institution. Summary of work A two-day course containing four key components was provided to pre-redeployment candidates. Day 1: Classroom–based teaching introducing COVID–19, infection prevention control and personal protective equipment use. Intermediate life support tutorials and low–fidelity simulation of a deteriorating patient. Day 2: Practical clinical skills session refreshers including venepuncture, cannulation, catheterisation, and arterial blood gas sampling. Followed by an opportunity to practice in a series of fully immersive high fidelity acute clinical scenarios proceeded by hot video–assisted debrief. Candidates completed pre and post course questionnaires. A follow up post course questionnaire will be sent out one-month post course. Unpaired (two tail) t-test analysis was used to analyse participant confidence scores pre and post course. Thematic analysis of qualitative feedback was also performed. Summary of Results Eighty-five candidates undertook the course with 76 (89%) completing pre & post questionnaires. Significant increases in candidate reported confidence were reported in; assessment of acutely unwell patients, leading a clinical team in the context of an acutely deteriorating patient and in handing over acutely unwell patients to senior acute clinicians. Candidates also reported significant confidence score increases regarding non-technical skills such as clinical decision making, demonstration of situational awareness, task management and team working. Participant qualitative feedback suggested three main advantages of the course: Simulation useful to tie up key skills learnt and to put skills into context, practical skills sessions useful refresher of common ward based activities, overall the faculty were enthusiastic and engaging and helped candidates to get the most out of the course. Discussion and Conclusions Our two-day multifaceted course provided non-acute medical and dental practitioners with significantly improved self-reported confidence in a number of key technical and non-technical domains. Clinical decision making and assessment of the deteriorating patient are critical for the maintenance of patient safety in the acute medical environment, in the context of medical human resource planning for a global pandemic. We hope that this course complemented ward based experiential learning at the start of the pandemic. References Imperial College London. Strengthening hospital capacity for the COVID-19pandemic. Available at: https://www.imperial.ac.uk/","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81424262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.177
Anna Thame, S. Goodchild, C. Hamilton, Jill Sainsbury
Introduction In 2019 the NMC published the standards for student supervision and assessment (NMC, 2019), stating that the role of practice supervisor (PS) and practice assessor (PA), previously combined in the role of mentor, should be separated as two distinct roles. Simulation-based education (SBE) underpinned a successful face-to-face, group based training for those new to the role of PS/PA and those requiring an update. The COVID-19 pandemic required the conversion of this face-to-face training with live simulation, into an online environment (HEE, 2020) Methods Subject matter experts from a healthcare Trust, an independent education academy and a media company, worked collaboratively with actor role-players from a simulated patient provider, for three months. Previously used learning material signposted the content, although in keeping with best practice, the course was re-written to become interactive rather than didactic. Actor role-players as student and PS/PA, simulated placement interviews, with interactive learning specifically applied to those simulations. This was integral to the modular course enabling remote self-directed learning. Results The ASPiH standards for SBE were central to the conversion of face-to-face, group based simulation into virtual learning. A modular course (reflecting the NMC standards) for qualified health professionals who are ‘supervising and assessing’ student nurses, has been successfully designed (Duffy, 2003). Hundreds of hours of translating learning material and filming of simulated scenarios have resulted in a training course that is fit for purpose, valuable for student nurses and qualified staff, highly shareable at a national level and amendable to suit differing audiences. Discussion Converting face-to-face, group based training with live simulation, into an online course is immensely challenging and risks being a didactic PowerPoint that disengages with minimal educational outcome. Creation of a successful course requires time, energy, and the ability to translate. If done well (high quality, standardised and rigorous), learners, educators and ultimately patients benefit. References Nursing and Midwifery Council ( 2019) Realising professionalism: Standards for education and training. Part 2: Standards for student supervision and assessment, https://www.nmc.org.uk/standards-for-education-and-training/standards-for-student-supervision-and-assessment/accessed 01/05/2020 Health Education England ( 2020) COVID-19 tool kit for safe simulation in healthcare, guidance and principles of best practice in simulation-based education and training, https://www.hee.nhs.uk/sites/default/files/documents/COVID-19%20toolkit%20for%20safe%20simulation.pdf accessed 25/08/2020 Duffy, K. ( 2003) Failing students: a qualitative study of factors that influence the decisions regarding assessment of students’ competence in practice. Glasgow: Glasgow Caledonian University. Available from: http://www.nmc-uk.org/Documents/Archi
{"title":"PG129 Converting a practice supervisor and assessor simulation to an online training course","authors":"Anna Thame, S. Goodchild, C. Hamilton, Jill Sainsbury","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.177","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.177","url":null,"abstract":"Introduction In 2019 the NMC published the standards for student supervision and assessment (NMC, 2019), stating that the role of practice supervisor (PS) and practice assessor (PA), previously combined in the role of mentor, should be separated as two distinct roles. Simulation-based education (SBE) underpinned a successful face-to-face, group based training for those new to the role of PS/PA and those requiring an update. The COVID-19 pandemic required the conversion of this face-to-face training with live simulation, into an online environment (HEE, 2020) Methods Subject matter experts from a healthcare Trust, an independent education academy and a media company, worked collaboratively with actor role-players from a simulated patient provider, for three months. Previously used learning material signposted the content, although in keeping with best practice, the course was re-written to become interactive rather than didactic. Actor role-players as student and PS/PA, simulated placement interviews, with interactive learning specifically applied to those simulations. This was integral to the modular course enabling remote self-directed learning. Results The ASPiH standards for SBE were central to the conversion of face-to-face, group based simulation into virtual learning. A modular course (reflecting the NMC standards) for qualified health professionals who are ‘supervising and assessing’ student nurses, has been successfully designed (Duffy, 2003). Hundreds of hours of translating learning material and filming of simulated scenarios have resulted in a training course that is fit for purpose, valuable for student nurses and qualified staff, highly shareable at a national level and amendable to suit differing audiences. Discussion Converting face-to-face, group based training with live simulation, into an online course is immensely challenging and risks being a didactic PowerPoint that disengages with minimal educational outcome. Creation of a successful course requires time, energy, and the ability to translate. If done well (high quality, standardised and rigorous), learners, educators and ultimately patients benefit. References Nursing and Midwifery Council ( 2019) Realising professionalism: Standards for education and training. Part 2: Standards for student supervision and assessment, https://www.nmc.org.uk/standards-for-education-and-training/standards-for-student-supervision-and-assessment/accessed 01/05/2020 Health Education England ( 2020) COVID-19 tool kit for safe simulation in healthcare, guidance and principles of best practice in simulation-based education and training, https://www.hee.nhs.uk/sites/default/files/documents/COVID-19%20toolkit%20for%20safe%20simulation.pdf accessed 25/08/2020 Duffy, K. ( 2003) Failing students: a qualitative study of factors that influence the decisions regarding assessment of students’ competence in practice. Glasgow: Glasgow Caledonian University. Available from: http://www.nmc-uk.org/Documents/Archi","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81823381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.113
S. Edwards, E. Hyde, L. Keillor
Introduction Emergency Medicine is a unique speciality often meeting people at the worse moments of their life. Death is an everyday occurrence, and with that comes the skills needed to talk to patients and families about when their end of life may be nearing. The Royal College of Emergency Medicine‘s guidelines suggests health care practitioners need the skills to talk to these patients. Within our department, we have advanced care practitioners (ACP) working as independent practitioners. These ACPs come from a nursing, paramedic or physiotherapy background. They have had further masters level training to do this role. Our department advocates early conversations with patients who have a frailty score of 7, 8 or 9 as per the Rockwood frailty score. With our hospital supporting the signing of do not resuscitate forms by ACPs, provided they have had sufficient training. Methods We developed a full day course in October 2019 which incorporated some lecture-based teaching and then in-situ simulations within the emergency department. Teaching topics covered difficult conversations, do not attempt cardiopulmonary resuscitation and legal aspects. The four simulations were Scenario 1: An end Stage COPD patient who was on the maximum of medical intervention. Scenario 2: A very frail patient who had multiple comorbidities and presents with another pneumonia. Scenario 3: A patient with a GI malignancy who has a massive bleed. Scenario 4: A frail patient who has a head injury on warfarin. Our aim was to gather feedback to see what educational benefit this brought to our ACPs. Results 9 participants completed the pilot course, none of which had, had formal training to have this type of conversation. This is despite these ACPs all having a minimum of 5 years post qualification. All felt their confidence had increased from no confidence to neutral or fairly confident. They also felt this was useful for their training. Discussion and Conclusion This course has provided our ACPs the skills and confidence to have these difficult conversations with patients. Despite the small numbers involved it is positive first step. More work is needed in order to understand the clinical impact.
{"title":"PG65 Experiences of a pilot in-situ simulation course for advanced care practitioners in the emergency department to sign do not resuscitate forms for patients approaching the end of life","authors":"S. Edwards, E. Hyde, L. Keillor","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.113","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.113","url":null,"abstract":"Introduction Emergency Medicine is a unique speciality often meeting people at the worse moments of their life. Death is an everyday occurrence, and with that comes the skills needed to talk to patients and families about when their end of life may be nearing. The Royal College of Emergency Medicine‘s guidelines suggests health care practitioners need the skills to talk to these patients. Within our department, we have advanced care practitioners (ACP) working as independent practitioners. These ACPs come from a nursing, paramedic or physiotherapy background. They have had further masters level training to do this role. Our department advocates early conversations with patients who have a frailty score of 7, 8 or 9 as per the Rockwood frailty score. With our hospital supporting the signing of do not resuscitate forms by ACPs, provided they have had sufficient training. Methods We developed a full day course in October 2019 which incorporated some lecture-based teaching and then in-situ simulations within the emergency department. Teaching topics covered difficult conversations, do not attempt cardiopulmonary resuscitation and legal aspects. The four simulations were Scenario 1: An end Stage COPD patient who was on the maximum of medical intervention. Scenario 2: A very frail patient who had multiple comorbidities and presents with another pneumonia. Scenario 3: A patient with a GI malignancy who has a massive bleed. Scenario 4: A frail patient who has a head injury on warfarin. Our aim was to gather feedback to see what educational benefit this brought to our ACPs. Results 9 participants completed the pilot course, none of which had, had formal training to have this type of conversation. This is despite these ACPs all having a minimum of 5 years post qualification. All felt their confidence had increased from no confidence to neutral or fairly confident. They also felt this was useful for their training. Discussion and Conclusion This course has provided our ACPs the skills and confidence to have these difficult conversations with patients. Despite the small numbers involved it is positive first step. More work is needed in order to understand the clinical impact.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81833108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.80
D. Bogue, Fatima Zahir, Claudia Mech, Ribena Akhter, C. Kallappa, L. Bagshaw
Background Communication in a healthcare setting not only occurs between a patient and their parent team, but also between different healthcare teams. Given that patients admitted to hospital have ever more complex medical and social needs,1 collaboration between teams is essential. Communication is a key factor in effective interprofessional working and errors in communication are a key factor in incidences of unintentional patient harm, and a common reason for patient complaints.2 To attempt to improve multi-disciplinary communication amongst senior decision makers in our Trust, the MAPstop (Management Action Plan) simulation session was designed. Summary of Work The aim of the session was for senior paediatricians, anaesthetists and emergency medicine consultants to practise using the MAPstop communication intervention in a simulation scenario involving an acutely unwell child. MAPstop is used as follows: Clinician has a concern about patient care, the management plan or communication. Clinician states ‘I want a MAPstop between myself and person X, person Y and person Z – everyone else continue with the resuscitation.’ SBAR (situation, background, assessment, recommendation) discussion focussing on the concerns. Unanimous decision regarding action plan. The MAPstop intervention was trialled with consultants and senior trainees in paediatrics, anaesthetics and emergency medicine in our simulation centre. Participant feedback on the utility of the intervention and effectiveness of simulation teaching was obtained via a post-session questionnaire. Summary of Results The feedback response rate was 75% (3/4 participants). MAPstop was extremely well-received by all who participated, with one participant describing it as an ‘empowering tool to ensure discussion could occur’ and another felt the tool could be used by more junior staff to communicate what they want from consultants. The simulation session was felt to be ‘very realistic’ with ‘challenging situations’ better learnt about in a simulation setting as opposed to real life. Discussion and Conclusions We view MAPstop as a new paradigm for communication between senior decision makers during difficult clinical situations. Using simulation to teach the MAPstop approach moves us beyond the historical use of simulation mainly for perfecting the A to E assessment, towards optimising communication skills for all levels of decision makers, right up to consultants. Recommendations MAPstop needs to be trialled by other medical disciplines, and could also potentially be used to facilitate communication between clinicians and the hospital management team. References Greenaway D. Shape of training: securing the future of excellent patient care: final report of the independent review. 2013. https://www.gmc-uk.org/-/media/documents/shape-of-training-final-report_pdf-53977887.pdf Murphy JG, Dunn WF. Medical errors and poor communication. Chest 2010;138:1475–79. https://doi.org/10.1378/chest.10-2263.
{"title":"PG32 MAPstop: making difficult conversations easier","authors":"D. Bogue, Fatima Zahir, Claudia Mech, Ribena Akhter, C. Kallappa, L. Bagshaw","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.80","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.80","url":null,"abstract":"Background Communication in a healthcare setting not only occurs between a patient and their parent team, but also between different healthcare teams. Given that patients admitted to hospital have ever more complex medical and social needs,1 collaboration between teams is essential. Communication is a key factor in effective interprofessional working and errors in communication are a key factor in incidences of unintentional patient harm, and a common reason for patient complaints.2 To attempt to improve multi-disciplinary communication amongst senior decision makers in our Trust, the MAPstop (Management Action Plan) simulation session was designed. Summary of Work The aim of the session was for senior paediatricians, anaesthetists and emergency medicine consultants to practise using the MAPstop communication intervention in a simulation scenario involving an acutely unwell child. MAPstop is used as follows: Clinician has a concern about patient care, the management plan or communication. Clinician states ‘I want a MAPstop between myself and person X, person Y and person Z – everyone else continue with the resuscitation.’ SBAR (situation, background, assessment, recommendation) discussion focussing on the concerns. Unanimous decision regarding action plan. The MAPstop intervention was trialled with consultants and senior trainees in paediatrics, anaesthetics and emergency medicine in our simulation centre. Participant feedback on the utility of the intervention and effectiveness of simulation teaching was obtained via a post-session questionnaire. Summary of Results The feedback response rate was 75% (3/4 participants). MAPstop was extremely well-received by all who participated, with one participant describing it as an ‘empowering tool to ensure discussion could occur’ and another felt the tool could be used by more junior staff to communicate what they want from consultants. The simulation session was felt to be ‘very realistic’ with ‘challenging situations’ better learnt about in a simulation setting as opposed to real life. Discussion and Conclusions We view MAPstop as a new paradigm for communication between senior decision makers during difficult clinical situations. Using simulation to teach the MAPstop approach moves us beyond the historical use of simulation mainly for perfecting the A to E assessment, towards optimising communication skills for all levels of decision makers, right up to consultants. Recommendations MAPstop needs to be trialled by other medical disciplines, and could also potentially be used to facilitate communication between clinicians and the hospital management team. References Greenaway D. Shape of training: securing the future of excellent patient care: final report of the independent review. 2013. https://www.gmc-uk.org/-/media/documents/shape-of-training-final-report_pdf-53977887.pdf Murphy JG, Dunn WF. Medical errors and poor communication. Chest 2010;138:1475–79. https://doi.org/10.1378/chest.10-2263.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77178429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.62
K. Kuyt, J. Fenwick, Rod McIntosh, Victoria Withey, T. Chang, R. MacKinnon
Background High quality CPR has been shown to save lives and has been identified as the ‘primary component in influencing survival from cardiac arrest’ (1). The UK RQI Programme has been designed to improve resuscitation education for healthcare providers with mandated quarterly CPR training on a specially designed cart in the workplace (RQI, Laerdal Medical). Providing users with simulation training in a ‘low-intensity, high-frequency’ training program which delivers live feedback and on-going assessments. This work presents the preliminary findings regarding acceptability of the RQI programme to end-users Summary of Work Acceptability was evaluated using an online questionnaire, containing both closed-ended questions on a 5-point likert scale, and open-ended questions with a free-text box. The questionnaire was hosted on a third party survey site, and the hyperlink to access the questionnaire was sent to users via email who were then able to respond anonymously. Closed-ended questions were evaluated using descriptive statistics, while the responses to open-ended questions were evaluated for common themes. Summary of Results Thirty-seven users to date, from one hospital, responded to the questionnaire. 75.7% of respondents agreed that the RQI training programme tool had improved their ability to perform CPR. Common themes in response to questions regarding the users’ experience of the UK RQI programme were an improvement in confidence and skills, benefits of the regularity of training, and the good quality of feedback. However, some users felt that in person trainers provided better feedback. Additional negative themes centred on a lack of teamwork, and some users finding it difficult to achieve a passing score. 75% of respondents agreed, or strongly agreed that they would recommend the UK RQI programme to a colleague. Discussion and Conclusions User feedback was overall positive. Many users felt their skills had improved and had increased in confidence in their ability to perform CPR. The negative feedback regarding the difficulty in passing the RQI programme may in fact demonstrate an advantage of the RQI system. Assessment by an instructor has been shown to be subjective and potentially inaccurate regarding the quality of CPR being performed (2). The RQI cart has pre-set parameters, in line with resuscitation council UK guidelines, against which user performance is scored. In conclusion, preliminary findings suggest the RQI programme was well received by most users. Further developments of the RQI programme could work to increase aspects of team-work within the curriculum and explore additional formats for providing feedback. References Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, et al. Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013;128(4):417–35. Jones A, Lin Y, Nettel-
{"title":"PG13 National evaluation of a low-dose, high-frequency cardiac resuscitation quality improvement programme in the United Kingdom – user feedback preliminary findings","authors":"K. Kuyt, J. Fenwick, Rod McIntosh, Victoria Withey, T. Chang, R. MacKinnon","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.62","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.62","url":null,"abstract":"Background High quality CPR has been shown to save lives and has been identified as the ‘primary component in influencing survival from cardiac arrest’ (1). The UK RQI Programme has been designed to improve resuscitation education for healthcare providers with mandated quarterly CPR training on a specially designed cart in the workplace (RQI, Laerdal Medical). Providing users with simulation training in a ‘low-intensity, high-frequency’ training program which delivers live feedback and on-going assessments. This work presents the preliminary findings regarding acceptability of the RQI programme to end-users Summary of Work Acceptability was evaluated using an online questionnaire, containing both closed-ended questions on a 5-point likert scale, and open-ended questions with a free-text box. The questionnaire was hosted on a third party survey site, and the hyperlink to access the questionnaire was sent to users via email who were then able to respond anonymously. Closed-ended questions were evaluated using descriptive statistics, while the responses to open-ended questions were evaluated for common themes. Summary of Results Thirty-seven users to date, from one hospital, responded to the questionnaire. 75.7% of respondents agreed that the RQI training programme tool had improved their ability to perform CPR. Common themes in response to questions regarding the users’ experience of the UK RQI programme were an improvement in confidence and skills, benefits of the regularity of training, and the good quality of feedback. However, some users felt that in person trainers provided better feedback. Additional negative themes centred on a lack of teamwork, and some users finding it difficult to achieve a passing score. 75% of respondents agreed, or strongly agreed that they would recommend the UK RQI programme to a colleague. Discussion and Conclusions User feedback was overall positive. Many users felt their skills had improved and had increased in confidence in their ability to perform CPR. The negative feedback regarding the difficulty in passing the RQI programme may in fact demonstrate an advantage of the RQI system. Assessment by an instructor has been shown to be subjective and potentially inaccurate regarding the quality of CPR being performed (2). The RQI cart has pre-set parameters, in line with resuscitation council UK guidelines, against which user performance is scored. In conclusion, preliminary findings suggest the RQI programme was well received by most users. Further developments of the RQI programme could work to increase aspects of team-work within the curriculum and explore additional formats for providing feedback. References Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, et al. Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013;128(4):417–35. Jones A, Lin Y, Nettel-","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78891022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.73
R. Kerslake, J. Cooke, Alexandra J. Joy, M. Harris
Background Core principles of the NHS England’s Long Term Plan for Mental Health include development of PMH services and co-production with people with lived experience of services. Women suffering with PMH disorders often present first to clinicians who are not specialists. Training the wider workforce in assessment and management of PMH disorders is a priority. A simulation-based training programme was co-produced with service users in all stage, including debriefing. Summary of Work Three Service User Consultants (SUCs) were employed as faculty members for the design of scenarios. The SUCs were also trained to facilitate the debriefing of scenarios, alongside a psychiatrist. Quantitative and qualitative data was collected on the simulation participants’ confidence and knowledge as a result of the training. 12 domains aligned with Health Education England’s (HEE) PMH competency framework were assessed, alongside the value of service user involvement. Data was collected before, immediately after and 2 months after the training. Summary of Results 103 participants completed the training over 10 dates. Comparing confidence before and after the training, scores improved by between 15–28% in all 12 domains. 94% of participants graded the contributions of SUCs as either useful or very useful. These effects were sustained 2 months after the training. These effects were reflected in the qualitative feedback from participants. Qualitative feedback from participants identified an improvement in their knowledge as a result of the training, however it was not possible to demonstrate this statistically. Discussion and Conclusions This co-produced simulation based PMH programme increases confidence, knowledge and understanding amongst non-specialist health professionals from across the PMH care pathway on a number of domains aligned with the HEE perinatal MH competency framework. Participants were overwhelming in support of SUC involvement in the debriefing and noted that scenarios highly resembled real-life clinical encounters as a result. Providing SUCs with robust training, supervision and psychological support throughout the design and debriefing process is essential to the effectiveness and sustainability of the programme.
{"title":"PG24 Evaluation of a co-produced simulation based perinatal mental health (PMH) programme","authors":"R. Kerslake, J. Cooke, Alexandra J. Joy, M. Harris","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.73","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.73","url":null,"abstract":"Background Core principles of the NHS England’s Long Term Plan for Mental Health include development of PMH services and co-production with people with lived experience of services. Women suffering with PMH disorders often present first to clinicians who are not specialists. Training the wider workforce in assessment and management of PMH disorders is a priority. A simulation-based training programme was co-produced with service users in all stage, including debriefing. Summary of Work Three Service User Consultants (SUCs) were employed as faculty members for the design of scenarios. The SUCs were also trained to facilitate the debriefing of scenarios, alongside a psychiatrist. Quantitative and qualitative data was collected on the simulation participants’ confidence and knowledge as a result of the training. 12 domains aligned with Health Education England’s (HEE) PMH competency framework were assessed, alongside the value of service user involvement. Data was collected before, immediately after and 2 months after the training. Summary of Results 103 participants completed the training over 10 dates. Comparing confidence before and after the training, scores improved by between 15–28% in all 12 domains. 94% of participants graded the contributions of SUCs as either useful or very useful. These effects were sustained 2 months after the training. These effects were reflected in the qualitative feedback from participants. Qualitative feedback from participants identified an improvement in their knowledge as a result of the training, however it was not possible to demonstrate this statistically. Discussion and Conclusions This co-produced simulation based PMH programme increases confidence, knowledge and understanding amongst non-specialist health professionals from across the PMH care pathway on a number of domains aligned with the HEE perinatal MH competency framework. Participants were overwhelming in support of SUC involvement in the debriefing and noted that scenarios highly resembled real-life clinical encounters as a result. Providing SUCs with robust training, supervision and psychological support throughout the design and debriefing process is essential to the effectiveness and sustainability of the programme.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86409643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.101
Rose English, Jeremy Hill, Maximilian Neun, A. Hulme, Anna M. Collinson, E. Hoogenboom
Background In situ simulation is an effective tool for rehearsing high risk situations (Patterson et al, 2013), detecting latent risks and testing operational readiness (Kobayashi et al, 2006). In anticipation of an influx of patients requiring intubation for COVID-19, we used simulation to identify and mitigate latent risks, rehearse team dynamics and improve staff confidence before the start of the pandemic. Summary of Project In March 2020, we delivered eleven in-situ simulations in the emergency department and the newly appointed intensive care overflow area in theatres. Participants were expected to perform a rapid sequence induction (RSI) using a new COVID-19 RSI checklist and airway grab box on an airway mannequin. Extra staff observed in active roles, delivering feedback on technical and non-technical skills. Post-simulation debrief identified learning points and latent threats requiring system changes. These were shared with staff dynamically throughout the process. We produced and distributed an exemplar video as an educational tool for those unable to attend. Feedback assessed how the training had influenced participants’ clinical practice and preparedness. Results Participants included anaesthetic, intensive care and emergency department doctors, nurses and operating department practitioners. Table 1 shows examples of learning points identified: Discussion Simulations were well attended. Debriefs yielded technical and non-technical learning points. Participants valued the opportunity to rehearse non-usual steps and communication in PPE. The majority reported reduced anxiety levels as a result of the training. Identified latent threats triggered revisions to policy, RSI checklist and airway grab box contents. Challenges included a need to preserve PPE, short preparation time and limited staff availability of both facilitators and participants due to ongoing elective work. Recommendations Our experience supports the use of in situ simulation for rapid staff training, as well as timely testing and refinement of new systems prior to clinical use in the context of the COVID-19 pandemic. Reference Kobayashi L, Shapiro MJ, Sucov A, Woolard R, Boss RM, Dunbar J, Sciamacco R, Karpik K and Jay G. Portable advanced medical simulation for new emergency department testing and orientation. Acad Emerg Med 2006;13(6):pp. 691–5. Patterson MD, Geis GL, Falcone RA, LeMaster T. and Wears RL. In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf 2013;22(6):pp. 468–77.
现场模拟是演练高风险情况(Patterson et al .， 2013)、发现潜在风险和测试作战准备情况(Kobayashi et al .， 2006)的有效工具。由于预计COVID-19需要插管的患者会大量涌入，我们在大流行开始之前使用模拟来识别和减轻潜在风险，排练团队动态并提高员工信心。2020年3月，我们在急诊科和新指定的手术室重症监护溢出区进行了11次现场模拟。预计参与者将使用新的COVID-19 RSI检查表和气道抓取盒在气道人体模型上执行快速序列诱导(RSI)。额外的员工被观察到积极的角色，提供技术和非技术技能的反馈。模拟后汇报确定了需要系统更改的学习点和潜在威胁。这些信息在整个过程中与员工动态共享。我们制作并分发了一个示范视频，作为无法参加的人的教育工具。反馈评估了培训如何影响参与者的临床实践和准备工作。结果参与者包括麻醉科、重症监护科和急诊科医生、护士和手术科从业人员。表1显示了确定的学习点的示例:汇报产生了技术和非技术的学习要点。与会者很重视这次演练个人防护装备非常规步骤和沟通的机会。大多数人报告说，训练的结果是焦虑水平降低了。确定了潜在威胁，触发了对政策、RSI检查表和气道抓取箱内容的修订。挑战包括需要保存个人防护装备，准备时间短，由于正在进行的选择性工作，辅助人员和参与者的可用性有限。我们的经验支持在COVID-19大流行背景下使用现场模拟进行快速工作人员培训，以及在临床使用之前及时测试和改进新系统。参考文献Kobayashi L, Shapiro MJ, Sucov A, Woolard R, Boss RM, Dunbar J, Sciamacco R, Karpik K, Jay G.便携式先进医学模拟新急诊科测试和定位。中华医学杂志，2006;13(6):pp。691 - 5。Patterson MD, Geis GL, Falcone RA, LeMaster T.和Wears RL。现场模拟:高风险急诊科安全威胁检测与团队合作训练。中华医学杂志，2013;22(6):pp。468 - 77。
{"title":"PG53 COVID 19 Intubation Simulation: Preparing for the new normal at UCLH","authors":"Rose English, Jeremy Hill, Maximilian Neun, A. Hulme, Anna M. Collinson, E. Hoogenboom","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.101","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.101","url":null,"abstract":"Background In situ simulation is an effective tool for rehearsing high risk situations (Patterson et al, 2013), detecting latent risks and testing operational readiness (Kobayashi et al, 2006). In anticipation of an influx of patients requiring intubation for COVID-19, we used simulation to identify and mitigate latent risks, rehearse team dynamics and improve staff confidence before the start of the pandemic. Summary of Project In March 2020, we delivered eleven in-situ simulations in the emergency department and the newly appointed intensive care overflow area in theatres. Participants were expected to perform a rapid sequence induction (RSI) using a new COVID-19 RSI checklist and airway grab box on an airway mannequin. Extra staff observed in active roles, delivering feedback on technical and non-technical skills. Post-simulation debrief identified learning points and latent threats requiring system changes. These were shared with staff dynamically throughout the process. We produced and distributed an exemplar video as an educational tool for those unable to attend. Feedback assessed how the training had influenced participants’ clinical practice and preparedness. Results Participants included anaesthetic, intensive care and emergency department doctors, nurses and operating department practitioners. Table 1 shows examples of learning points identified: Discussion Simulations were well attended. Debriefs yielded technical and non-technical learning points. Participants valued the opportunity to rehearse non-usual steps and communication in PPE. The majority reported reduced anxiety levels as a result of the training. Identified latent threats triggered revisions to policy, RSI checklist and airway grab box contents. Challenges included a need to preserve PPE, short preparation time and limited staff availability of both facilitators and participants due to ongoing elective work. Recommendations Our experience supports the use of in situ simulation for rapid staff training, as well as timely testing and refinement of new systems prior to clinical use in the context of the COVID-19 pandemic. Reference Kobayashi L, Shapiro MJ, Sucov A, Woolard R, Boss RM, Dunbar J, Sciamacco R, Karpik K and Jay G. Portable advanced medical simulation for new emergency department testing and orientation. Acad Emerg Med 2006;13(6):pp. 691–5. Patterson MD, Geis GL, Falcone RA, LeMaster T. and Wears RL. In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf 2013;22(6):pp. 468–77.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82798476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.92
S. Pearson, Jemma White, B. Heath
Background In-situ simulation allows for learning in the environment in which it is to be used. This allows identification of latent error, organisational challenges presented by the environment as well as providing learning opportunities for staff such as refreshing clinical knowledge and improved human factors awareness (Schofield et al, 2018). In-situ simulation can also prepare staff to more easily take up specific roles in stressful but infrequent situations such as cardiac arrest and poly trauma cases (Schofield et al, 2018). There is also evidence that people who have undergone simulation training for events like cardiac arrest have better skills in practice (Mondrup et al, 2011). We modified an existing in-situ simulation programme within our hospital to help prepare for the ongoing Covid-19 Pandemic. Summary of Work During the Covid-19 pandemic new clinical guidelines and procedures were introduced in a short space of time. We used in-situ simulation as a tool to teach new practices to staff, but also as a safe way to identify latent risk. Our two examples explored within this poster presentation include stress testing of the re-located paediatric emergency department which was moved to accommodate the new Covid-19 assessment area and a multi-speciality and interdisciplinary simulation to test cardiac arrest guidelines in a patient with Covid-19. As a result of these simulations changes to practice and organisation of the work environment were implemented to improve patient safety and care. We also identified some limitations to performing in-situ simulation during a pandemic. The loss of protected teaching time impacted simulation as staff carrying out this work had to be re-deployed clinically. During busy periods space in the department was reduced and limited the ability to perform simulation. Equipment issues also arose such as the act of simulating a Covid-19 scenario used up PPE stocks which initially were in short supply. Discussion We feel that our work shows the value of in-situ simulation in preparing hospitals for management of Covid-19 patients. It allows for the testing of new guidelines and departmental re-organisation, provides learning to staff from different disciplines and different specialities within the hospital and allows identification of latent risks. With the potential for a second wave of Covid-19 early testing of hospital preparedness using in-situ simulation to check planned guidelines and operating procedures will help to strengthen staff knowledge, increase familiarity with new policies or procedures and can highlight safety issues due to environment or equipment limitations. References Schofield, L. Welfare, E. & Mercer, S. In-situ simulation. Trauma 2018;Vol 20:p281–p288. Mondrup, F. Brabrand, M. Folkestad, L. Oxlund, J. Wiborg, K. Sand, N. & Knudsen, T. In-hospital resuscitation evaluated by in situ simulation; a prospective simulation study. Scandinavian Journal of Trauma, Resuscitation and Emergency Me
现场模拟允许在使用它的环境中进行学习。这可以识别潜在的错误，环境带来的组织挑战，并为员工提供学习机会，例如更新临床知识和提高人为因素意识(Schofield等人，2018)。现场模拟还可以使工作人员在压力大但不常见的情况下(如心脏骤停和多重创伤病例)更容易担任特定角色(Schofield等人，2018)。也有证据表明，接受过心脏骤停等事件模拟训练的人在实践中有更好的技能(Mondrup et al, 2011)。我们修改了医院内现有的现场模拟程序，以帮助为正在进行的Covid-19大流行做好准备。在2019冠状病毒病大流行期间，短时间内推出了新的临床指南和程序。我们使用现场模拟作为向员工传授新实践的工具，同时也是一种识别潜在风险的安全方法。我们在这张海报展示中探讨了两个例子，包括对重新安置的儿科急诊科进行压力测试，该急诊科为适应新的Covid-19评估区域而搬迁，以及对Covid-19患者进行多专业和跨学科模拟，以测试心脏骤停指南。这些模拟的结果改变了实践和工作环境的组织，以提高患者的安全和护理。我们还确定了在大流行期间进行现场模拟的一些限制。受保护的教学时间的损失影响了模拟，因为执行这项工作的工作人员必须重新部署到临床。在繁忙时期，该部门的空间减少，限制了进行模拟的能力。设备问题也出现了，例如模拟Covid-19情景的行为耗尽了最初供应短缺的个人防护装备库存。我们认为，我们的工作显示了现场模拟在医院准备管理Covid-19患者中的价值。它允许测试新的指导方针和部门重组，为医院内不同学科和不同专业的工作人员提供学习机会，并允许识别潜在风险。由于有可能出现第二波Covid-19疫情，利用现场模拟来检查计划的指导方针和操作程序，对医院准备情况进行早期测试，将有助于加强工作人员的知识，增加对新政策或程序的熟悉程度，并可以突出由于环境或设备限制而导致的安全问题。参考文献Schofield, L. Welfare, E. & Mercer, S.原位模拟。创伤2018;Vol 20: p281-p288。Mondrup, F. Brabrand, M. Folkestad, L. Oxlund, J. Wiborg, K. Sand, N. & Knudsen, T.原位模拟评估院内复苏;前瞻性模拟研究。斯堪的纳维亚创伤、复苏和急诊医学杂志2011;Vol 19: p55-p60。
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Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.119
Vivienne Greening
Background Throughout March this year, UK Government announced numerous initiatives to protect the NHS, ensure its ability to cope with demands of the pandemic, ultimately saving lives.1 Redeployment of staff and the training needed to maintain quality and safety, was an acknowledged essential step in the management of COVID-19.2 Locally to stabilise unpredictable ward staffing levels, nurses working in a non-ward based role were required to be redeployed to meet service needs. They were required to support an established ward in delivering more complex elements of care to an increased number of patients whilst maintaining a high-standard approach to patient safety. As a departure from the standard staffing model, it was identified that additional training was required. The Clinical Education Team were asked to develop and implement this. Summary of Work Ward Surge Nurse Training was developed and commenced on 26th March 2020, running Tuesday to Friday for the following four weeks. The session was four hours in length, with capacity restricted to 16 to maintain participant safety by social distancing. Training comprised of a PowerPoint presentation, interactive clinical skill workshop stations and simulated clinical environments with content based on current evidence-based practice along with GSTFT clinical guidance, policies, and training. A scope of practice and e-learning were sent out to participants prior to attendance. As of 7th May 2020, 124 adult nurses, 20 paediatric nurses, two midwives and three school nurses/health visitors and five undisclosed practitioners have attended this training. Summary of Results An evaluation form was sent to participants’ to evaluate levels of confidence following their training, assess if content was suitable to their needs and whether the training achieved the learning outcomes. Synopsis of key findings: delivered learning objectives, training delivered well, relevant clinical skills, simulated set up interactive and provided opportunity to practice, participants felt prepared and reassured. However additional skill gaps were identified and varying experience of participants within a group discouraged confidence in some. Discussion and Conclusion Despite the restricted time-frame and the urgency of implementation, the training developed prepared surge nurses for their role in the ward area during the pandemic. The simulated environment facilitated the opportunity to practice skills, interact with skilled clinicians thus preparing and reassuring participants. Recommendation Having successfully implemented this training, particularly the benefit of clinical simulation, it would be suggested that this training should continue to be used during this pandemic and any future emergencies. Reference PM address to the nation on coronavirus - 23 March 2020. Available at: https://www.gov.uk/government/speeches/pm-address-to-the-nation-on-coronavirus-23-march-2020 Redeploying your secondary care medical workforce saf
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