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”.

scholarly journals Simulation-Based Training Program to Improve Cardiopulmonary Resuscitation and Teamwork Skills for the Urgent Care Clinic Staff

2021 ◽  
Author(s):  
Rupert Biacora Laco ◽  
Wilma Powell Stuart
Keyword(s):  
Patient Safety ◽  
Urgent Care ◽  
Improvement Project ◽  
Care Clinic ◽  
In Situ Simulation ◽  
Simulation Based ◽  
Urgent Care Clinic ◽  
Teamwork Skills ◽  
Cpr Training

ABSTRACT Introduction Lack of high-quality cardiopulmonary resuscitation (CPR) and effective team communication during cardiovascular emergencies could lead to poor patient outcomes and adverse events. Studies have shown that CPR psychomotor skills declined 3 months and plateaued up to 6 months after the completion of CPR training. The Urgent Care Clinic (UCC) interprofessional staff did not receive consistent training on CPR and teamwork skills beyond what was received from the biannual American Red Cross (ARC) Basic Life Support (BLS) training and semiannual Resuscitative Care Function mock cardiac arrest. Most participants took their last CPR training for more than 6 months (n = 12, 67%), between 3 and 6 months (n = 2, 11%), and within the last 3 months before the pre-intervention period (n = 4, 22%). The purpose of the project was to form an interprofessional team to lead the development and implementation of a theory- and evidence-based simulation-based training program to improve CPR and teamwork skills while enhancing patient safety and emergency medical readiness in the hospital and UCC. Materials and Methods The quality improvement project utilized an interprofessional in situ simulation-based training to improve participants’ CPR and teamwork skills. The UCC physicians, nurses, and medical technicians completed a CPR and teamwork simulation-based training with a high-fidelity mannequin, pre-simulation preparation, briefing, and debriefing. The project collected pre-intervention and post-intervention data for CPR competence and teamwork perceptions. A paired t-test was used to assess differences in participant CPR skills and Team Strategies to Enhance Performance and Patient Safety Teamwork Perceptions Questionnaire responses before and after the simulation-based training intervention. The 59th Medical Wing and the University of South Alabama Institutional Review Boards approved the quality improvement project. Results A total of 18 participants completed the ARC BLS and Team Strategies to Enhance Performance and Patient Safety simulation-based training. Most participants were medical technicians (n = 8, 44%), followed by physicians (n = 5, 28%) and (n = 5, 28%) nurses. There was a statistical significance in participants’ ARC BLS scores, with a pre-simulation mean score of 45.42 and a post-simulation mean score of 89.21 (P = .000, 95% CI = 36.89-50.68). For Team Strategies to Enhance Performance and Patient Safety teamwork perceptions, there was a statistically significant increase in the participants’ teamwork perception levels, with a pre-simulation mean score of 4.61 and a post-simulation mean score of 4.86 (P = .000, 95% CI = 0.20-0.31). Conclusions Our results demonstrated that the participants’ ARC BLS scores and UCC’s team perceptions have increased after in situ simulation-based training. We did not assess the ideal time for re-training. We recommend a 3- to 6-month post-training assessment to determine the optimal time for a CPR and teamwork refresher training. A high-fidelity simulation-based program with trained facilitators that assess the healthcare providers’ CPR and teamwork skills could enhance the delivery of high-quality CPR and execution of effective teamwork skills in their workplace.

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 IMPROVING SYSTEM READINESS, STAFF PREPAREDNESS AND PATIENT SAFETY IN A NEW SINGLE FAMILY ROOM NICU THROUGH IN SITU SIMULATION

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e16-e16
Author(s):  
Ahmed Moussa ◽  
Audrey Larone-Juneau ◽  
Laura Fazilleau ◽  
Marie-Eve Rochon ◽  
Justine Giroux ◽  
...  
Keyword(s):  
Patient Safety ◽  
Repeated Measures ◽  
Large Scale ◽  
Multidisciplinary Teams ◽  
Single Family ◽  
In Situ Simulation ◽  
Ensure Patient Safety ◽  
System Readiness ◽  
Dependent Samples

Abstract BACKGROUND Transitions to new healthcare environments can negatively impact patient care and threaten patient safety. Immersive in situ simulation conducted in newly constructed single family room (SFR) Neonatal Intensive Care Units (NICUs) prior to occupancy, has been shown to be effective in testing new environments and identifying latent safety threats (LSTs). These simulations overlay human factors to identify LSTs as new and existing process and systems are implemented in the new environment OBJECTIVES We aimed to demonstrate that large-scale, immersive, in situ simulation prior to the transition to a new SFR NICU improves: 1) systems readiness, 2) staff preparedness, 3) patient safety, 4) staff comfort with simulation, and 5) staff attitude towards culture change. DESIGN/METHODS Multidisciplinary teams of neonatal healthcare providers (HCP) and parents of former NICU patients participated in large-scale, immersive in-situ simulations conducted in the new NICU prior to occupancy. One eighth of the NICU was outfitted with equipment and mannequins and staff performed in their native roles. Multidisciplinary debriefings, which included parents, were conducted immediately after simulations to identify LSTs. Through an iterative process issues were resolved and additional simulations conducted. Debriefings were documented and debriefing transcripts transcribed and LSTs classified using qualitative methods. To assess systems readiness and staff preparedness for transition into the new NICU, HCPs completed surveys prior to transition, post-simulation and post-transition. Systems readiness and staff preparedness were rated on a 5-point Likert scale. Average survey responses were analyzed using dependent samples t-tests and repeated measures ANOVAs. RESULTS One hundred eight HCPs and 24 parents participated in six half-day simulation sessions. A total of 75 LSTs were identified and were categorized into eight themes: 1) work organization, 2) orientation and parent wayfinding, 3) communication devices/systems, 4) nursing and resuscitation equipment, 5) ergonomics, 6) parent comfort; 7) work processes, and 8) interdepartmental interactions. Prior to the transition to the new NICU, 76% of the LSTs were resolved. Survey response rate was 31%, 16%, 7% for baseline, post-simulation and post-move surveys, respectively. System readiness at baseline was 1.3/5,. Post-simulation systems readiness was 3.5/5 (p = 0.0001) and post-transition was 3.9/5 (p = 0.02). Staff preparedness at baseline was 1.4/5. Staff preparedness post-simulation was 3.3/5 (p = 0.006) and post-transition was 3.9/5 (p = 0.03). CONCLUSION Large-scale, immersive in situ simulation is a feasible and effective methodology for identifying LSTs, improving systems readiness and staff preparedness in a new SFR NICU prior to occupancy. However, to optimize patient safety, identified LSTs must be mitigated prior to occupancy. Coordinating large-scale simulations is worth the time and cost investment necessary to optimize systems and ensure patient safety prior to transition to a new SFR NICU.

scholarly journals Patient safety culture improves during an in situ simulation intervention: a repeated cross-sectional intervention study at two hospital sites

2021 ◽  
Vol 10 (1) ◽  
pp. e001183
Author(s):  
Anders Schram ◽  
Charlotte Paltved ◽  
Karl Bang Christensen ◽  
Gunhild Kjaergaard-Andersen ◽  
Hanne Irene Jensen ◽  
...  
Keyword(s):  
Patient Safety ◽  
Safety Culture ◽  
Intervention Study ◽  
Patient Safety Culture ◽  
Cross Sectional ◽  
In Situ Simulation ◽  
Culture Dimensions ◽  
Scale Scores ◽  
Safety Attitude

ObjectivesThis study aimed to investigate staff’s perceptions of patient safety culture (PSC) in two Danish hospitals before and after an in situ simulation intervention.DesignA repeated cross-sectional intervention study.SettingTwo Danish hospitals. Hospital 1 performs emergency functions, whereas hospital 2 performs elective functions.ParticipantsA total of 967 healthcare professionals were invited to participate in this study. 516 were employed in hospital 1 and 451 in hospital 2. Of these, 39 were trained as simulation instructors.InterventionA 4-day simulation instructor course was applied. Emphasis was put on team training, communication and leadership. After the course, instructors performed simulation in the hospital environment. No systematic simulation was performed prior to the intervention.Main outcome measuresThe Safety Attitude Questionnaire investigating PSC was applied prior to the intervention and again 4 and 8 weeks after intervention. The proportion of participants with a positive attitude and mean scale scores were measured as main outcomes.ResultsThe response rate varied from 63.6% to 72.0% across surveys and hospitals. Baseline scores were generally lower for hospital 1. The proportion of staff with positive attitudes in hospital 1 improved by ≥5% in five of six safety culture dimensions, whereas only two dimensions improved by ≥5% in hospital 2. The mean scale scores improved significantly in five of six safety culture dimensions in hospital 1, while only one dimension improved significantly in hospital 2.ConclusionsSafety attitude outcomes indicate an improvement in PSC from before to after the in situ simulation intervention period. However, it is possible that an effect is more profound in an acute care hospital versus an elective setting.

scholarly journals A Neonatal Intensive Care Unit’s Experience with Implementing an In-Situ Simulation and Debriefing Patient Safety Program in the Setting of a Quality Improvement Collaborative

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 202
Author(s):  
Mary Eckels ◽  
Terry Zeilinger ◽  
Henry C. Lee ◽  
Janine Bergin ◽  
Louis P. Halamek ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care ◽  
Quality Care ◽  
Neonatal Resuscitation ◽  
Healthcare Team ◽  
In Situ Simulation ◽  
Implementation Phase

Extensive neonatal resuscitation is a high acuity, low-frequency event accounting for approximately 1% of births. Neonatal resuscitation requires an interprofessional healthcare team to communicate and carry out tasks efficiently and effectively in a high adrenaline state. Implementing a neonatal patient safety simulation and debriefing program can help teams improve the behavioral, cognitive, and technical skills necessary to reduce morbidity and mortality. In Simulating Success, a 15-month quality improvement (QI) project, the Center for Advanced Pediatric and Perinatal Education (CAPE) and California Perinatal Quality Care Collaborative (CPQCC) provided outreach and training on neonatal simulation and debriefing fundamentals to individual teams, including community hospital settings, and assisted in implementing a sustainable program at each site. The primary Aim was to conduct two simulations a month, with a goal of 80% neonatal intensive care unit (NICU) staff participation in two simulations during the implementation phase. While the primary Aim was not achieved, in-situ simulations led to the identification of latent safety threats and improvement in system processes. This paper describes one unit’s QI collaborative experience implementing an in-situ neonatal simulation and debriefing program.

scholarly journals Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty Emergency Departments: A Prospective, In Situ, Simulation‐based Study

2018 ◽  
Vol 25 (12) ◽  
pp. 1396-1408 ◽  
Author(s):  
Marc Auerbach ◽  
Linda Brown ◽  
Travis Whitfill ◽  
Janette Baird ◽  
Kamal Abulebda ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Emergency Departments ◽  
In Situ Simulation ◽  
Simulation Based

scholarly journals Improving safety and reducing error in endoscopy: simulation training in human factors

2019 ◽  
Vol 10 (2) ◽  
pp. 160-166 ◽  
Author(s):  
Srivathsan Ravindran ◽  
Siwan Thomas-Gibson ◽  
Sam Murray ◽  
Eleanor Wood
Keyword(s):  
Human Factors ◽  
Simulation Training ◽  
Working Environment ◽  
Advisory Group ◽  
In Situ Simulation ◽  
Simulation Based ◽  
The Uk ◽  
Endoscopy Simulation ◽  
Patient Safety Incidents

Patient safety incidents occur throughout healthcare and early reports have exposed how deficiencies in ‘human factors’ have contributed to mortality in endoscopy. Recognising this, in the UK, the Joint Advisory Group for Gastrointestinal Endoscopy have implemented a number of initiatives including the ‘Improving Safety and Reducing Error in Endoscopy’ (ISREE) strategy. Within this, simulation training in human factors and Endoscopic Non-Technical Skills (ENTS) is being developed. Across healthcare, simulation training has been shown to improve team skills and patient outcomes. Although the literature is sparse, integrated and in situ simulation modalities have shown promise in endoscopy. Outcomes demonstrate improved individual and team performance and development of skills that aid clinical practice. Additionally, the use of simulation training to detect latent errors in the working environment is of significant value in reducing error and preventing harm. Implementation of simulation training at local and regional levels can be successfully achieved with collaboration between organisational, educational and clinical leads. Nationally, simulation strategies are a key aspect of the ISREE strategy to improve ENTS training. These may include integration of simulation into current training or development of novel simulation-based curricula. However used, it is evident that simulation training is an important tool in developing safer endoscopy.

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