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Sunday, September 26, 2010
Title: Stimulating Simulations: Developing Meaningful Insitu Simulations in a Level III Perinatal Center
Discipline: Women’s Health (WH), Professional Issues (PI), Newborn (NB), Childbearing (CB), Advanced Practice (AP)
Learning Objectives:
Submission Description:- Describe what makes simulations successful.
- Verbalize barriers to successful simulation demonstration.
- Discuss ways to improve and engage staff within a simulation scenario
Background: Communication failures account for 72% of perinatal sentinel events and are at the heart of most obstetric litigation claims. Healthcare professions are proficient at training an individual’s technical skills but not necessarily how to communicate effectively and perform as a team. In situ simulations have become a standard safety measure to assess and remediate communication issues, particularly for high risk clinical scenarios.
Purpose: The purpose is to describe our level III perinatal center’s experience with a multidisciplinary simulation program. The goal was achieved to have scheduled, realistic emergency scenarios to improve communication processes.
Method: In the summer of 2008, as part of the Premier Perinatal Safety Initiative, we re-invented our simulation training program. We began simulations in 2004 with the Vermont-Oxford Network but wanted to ‘tweak’ some elements discovered from our experience and recent benchmarking. One staff nurse and one physician stepped up to be simulation coordinators. They develop scenarios based on real-life cases and involve all disciplines. Simulations are performed monthly and staff are scheduled ‘out of unit’ time to attend. A pre-briefing is held in which roles are assigned and expectations set. The simulations are videotaped. Following the simulation, a group debriefing is held, the tape is reviewed and performance is discussed, focusing on teamwork and communication, rather than technique or skills. Afterwards, a ‘Clinical Teamwork Scale’ is completed by every simulation participant to monitor key aspects of team performance (communication, situational awareness, decision making and role responsibility). The last 4 simulations have seen the composite score improve from 7.3 to 9.0 (1-10 scale).
Discussion: Simulations have promoted staff involvement and key changes in practice. All disciplines have now committed a representative to the simulation team, as well as scheduling staff time to attend, removing a roadblock of the past, greatly improving the simulation experience, and promoting a culture of safety. During the debriefings, staff is recognized for ‘what went well’ and issues identified as ‘what did not go well’ are addressed. For example, during an emergency cesarean section, the primary nurse will now don a red hat, signifying she has the most complete patient information. Roles have been defined in policy, for example ‘RN1’, ‘RN2’ and ‘RN3’ in the OR, with delineated responsibilities that close possible gaps in communication. These simulations have also paved the way for current trialing of ‘Vocera’, a wireless communication device.
Conclusion: Insitu simulation drills have evolved considerably and will continue to do so. With multidisciplinary commitment, designated coordinators, scheduled staff time, and diligent follow-up to lessons learned, in situ simulations can be an effective tool to improve communication and safety.
Purpose: The purpose is to describe our level III perinatal center’s experience with a multidisciplinary simulation program. The goal was achieved to have scheduled, realistic emergency scenarios to improve communication processes.
Method: In the summer of 2008, as part of the Premier Perinatal Safety Initiative, we re-invented our simulation training program. We began simulations in 2004 with the Vermont-Oxford Network but wanted to ‘tweak’ some elements discovered from our experience and recent benchmarking. One staff nurse and one physician stepped up to be simulation coordinators. They develop scenarios based on real-life cases and involve all disciplines. Simulations are performed monthly and staff are scheduled ‘out of unit’ time to attend. A pre-briefing is held in which roles are assigned and expectations set. The simulations are videotaped. Following the simulation, a group debriefing is held, the tape is reviewed and performance is discussed, focusing on teamwork and communication, rather than technique or skills. Afterwards, a ‘Clinical Teamwork Scale’ is completed by every simulation participant to monitor key aspects of team performance (communication, situational awareness, decision making and role responsibility). The last 4 simulations have seen the composite score improve from 7.3 to 9.0 (1-10 scale).
Discussion: Simulations have promoted staff involvement and key changes in practice. All disciplines have now committed a representative to the simulation team, as well as scheduling staff time to attend, removing a roadblock of the past, greatly improving the simulation experience, and promoting a culture of safety. During the debriefings, staff is recognized for ‘what went well’ and issues identified as ‘what did not go well’ are addressed. For example, during an emergency cesarean section, the primary nurse will now don a red hat, signifying she has the most complete patient information. Roles have been defined in policy, for example ‘RN1’, ‘RN2’ and ‘RN3’ in the OR, with delineated responsibilities that close possible gaps in communication. These simulations have also paved the way for current trialing of ‘Vocera’, a wireless communication device.
Conclusion: Insitu simulation drills have evolved considerably and will continue to do so. With multidisciplinary commitment, designated coordinators, scheduled staff time, and diligent follow-up to lessons learned, in situ simulations can be an effective tool to improve communication and safety.
