The multidisciplinary simulation team at Baylor University Medical Center sought to expand training beyond the simulation lab and into the clinical setting in order to achieve a multidisciplinary, multi-unit team approach.  This would allow them to identify gaps in communication and process issues therefore implementing change before any harm was done to a patient.

Proposed change:

To evaluate clinical skills, as well as the communication and processes on the units, the simulation team chose to implement in-situ simulation drills in an effort to capture real world experiences along with the multidisciplinary team’s performance. 

In order to effectively plan and operationalize the in-situ simulation drills, the team devised high risk, low volume scenarios based on the input from the unit educators, risk management and patient safety. The staff on the units were unaware of the upcoming drill in order to fully capture their knowledge, skills and communication patterns in these high stress scenarios.  Video recording captured the scenario as it unfolded and appropriate high and low fidelity simulators were used to mimic the most realistic scenario possible.  Immediately following the scenario, the staff debriefed the video recorded event.   In the facilitated debriefing the participants were able to recognize gaps in communication, identify errors in clinical skills, acknowledge teamwork deficiencies, ascertain the need for a leader, as well as, identify process issues that required immediate change One of the common themes discussed in the debriefing was the need to implement more effective communication as well as the need to establish a common language to help bridge the gap in understanding spoken terminology to ultimately optimize patient safety.

Implications for nursing practice:

In-situ drills allow for a more accurate evaluation of knowledge, clinical skills and behavioral skills among the healthcare team, especially in relation to gaps in communication that can lead to the increased risk for errors or near misses.  Facilitated video recorded debriefing allows participants to recognize gaps in performance.  Utilizing simulation for in-situ drills creates a safer environment for the patient especially in these high risk, low volume situations.  

Keywords: Simulation; In-situ; Drills, Perinatal; Sim