scholarly journals Rapid Cycle Deliberate Practice to Facilitate “Nano” In Situ Simulation: An Interprofessional Approach to Just-in-Time Training

2021 ◽  
Vol 41 (1) ◽  
pp. e1-e8
Author(s):  
Kristen M. Brown ◽  
Shawna S. Mudd ◽  
Julianne S. Perretta ◽  
Adam Dodson ◽  
Elizabeth A. Hunt ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Patient Safety ◽  
Intensive Care ◽  
Simulation Training ◽  
Deliberate Practice ◽  
Care Providers ◽  
In Situ Simulation ◽  
Practice Method

Background Simulation is increasingly used to identify latent threats to patient safety, such as delays in recognition and management of time-sensitive conditions. The Rapid Cycle Deliberate Practice teaching method may facilitate “nano” (brief) in situ simulation training in a critical care setting to improve multidisciplinary team performance of time-sensitive clinical tasks. Objective To determine whether nano–in situ simulation training with Rapid Cycle Deliberate Practice can improve pediatric intensive care unit team proficiency in identifying and managing postoperative shock in a pediatric cardiac patient. Methods A quality improvement educational project was conducted involving nano–in situ simulation sessions in a combined pediatric and pediatric cardiac intensive care unit. The Rapid Cycle Deliberate Practice method was used with an expert-driven checklist for 30-minute simulation scenarios. Results A total of 23 critical care providers participated. The proportion of time-sensitive tasks completed within 5 minutes increased significantly from before to after training (52% [13 of 25] vs 100% [25 of 25]; P ≤ .001). Using a 5-point Likert scale, with higher scores indicating higher levels, the participants reported high degrees of performance confidence (mean, 4.42; SD, 0.20) and satisfaction with the simulation experience (mean, 4.96; SD, 0.12). Conclusion The Rapid Cycle Deliberate Practice method was used to facilitate nano–in situ simulation training and identify areas requiring additional education to improve patient safety. In situ simulation can educate providers in a cost-effective and timely manner.

125 INTRODUCING AN IN SITU SIMULATION PROGRAMME IN AN INTENSIVE CARE UNIT

2021 ◽  
Author(s):  
Harry Bateman ◽  
Karen Johnston ◽  
Andrew Badacsonyi ◽  
Natalie Clarke ◽  
Kathleen Conneally ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Human Factors ◽  
Professional Training ◽  
In Situ Simulation ◽  
Airline Pilots ◽  
Staff Members ◽  
Emergency Scenarios ◽  
The Impact

This North London hospital has a 14-bed Intensive Care Unit (ICU). As a small District General ICU, staff exposure to emergency scenarios can be infrequent. Lack of practice can lead to a reduction in staff confidence and knowledge when these scenarios are encountered, especially during the COVID pandemic. The ICU had not previously undertaken in situ multi-disciplinary team (MDT) simulation sessions on the unit.The aim of the study was to introduce a novel programme of MDT simulation sessions in the ICU and provide feedback with the aim of increasing both staff confidence in managing emergency scenarios and staff understanding of the impact of human factors.A team of ICU Simulation Champions created emergency scenarios that could occur in the ICU. Pre-simulation and post-simulation questionnaires were produced to capture staff opinion on topics including benefits and barriers to simulation training and confidence in managing ICU emergencies. Members of the ICU MDT would be selected to participate in simulation scenarios. Afterwards, debrief sessions would be facilitated by Simulation Champions and Airline Pilots with a particular focus on competence in managing the emergency and human factors elements, such as communication and leadership. Participants would then be surveyed with the post-simulation questionnaire.Nine simulation sessions were conducted between October 2020 and June 2021. The sessions occurred within the ICU during the working day in a designated bay with the availability of all standard ICU resources and involved multiple MDT members to aid fidelity. Feedback by Simulation Champions mainly focussed on knowledge related to the ICU emergency, whilst the Airline Pilots provided expert feedback on human factors training. Fifty-five staff members completed the pre-simulation questionnaire and 37 simulation participants completed the post-simulation questionnaire. Prior to simulation participation, 28.3% of respondents agreed they felt confident managing emergency scenarios on ICU – this figure increased to 54.1% following simulation participation. 94.4% of simulation participants agreed that their knowledge of human factors had improved following the simulation and 100% of participants wanted further simulation teaching. Figure 1 shows a thematic analysis of the responses from 31 participants who were questioned about perceived benefits from simulation teaching. Following the success of the programme, the Hospital Trust will continue to support and develop inter-speciality and inter-professional training, and have funded the appointment of an ICU Simulation Fellow to continue to lead and enhance future in situ simulation teaching on the ICU.

scholarly journals Family Behaviors as Unchanging Obstacles in End-of-Life Care: 16-Year Comparative Data

2020 ◽  
Vol 29 (4) ◽  
pp. e81-e91
Author(s):  
Renea L. Beckstrand ◽  
Jasmine B. Jenkins ◽  
Karlen E. Luthy ◽  
Janelle L. B. Macintosh
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Critical Care Nurses ◽  
Life Care ◽  
Care Providers ◽  
Over Time

Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined. Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time. Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999. Results Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient’s end-of-life wishes, and not understanding the meaning of the term lifesaving measures). Two were related to nurse issues. Seven obstacles decreased in magnitude, including poor design of units, overly restrictive visiting hours, and physicians avoiding conversations with families. Four helpful behavior magnitude scores increased significantly over time, including physician agreement on patient care and family access to the patient. Three helpful behavior items decreased in magnitude, including intensive care unit design. Conclusions The same end-of-life care obstacles that were reported in 1999 are still present. Obstacles related to family behaviors increased significantly, whereas obstacles related to intensive care unit environment or physician behaviors decreased significantly. These results indicate a need for better end-of-life education for families and health care providers.

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.

Use of in situ simulation to evaluate the operational readiness of a high‐consequence infectious disease intensive care unit

Anaesthesia ◽  
2020 ◽  
Vol 75 (6) ◽  
pp. 733-738 ◽  
Author(s):  
T. E. Fregene ◽  
P. Nadarajah ◽  
J. F. Buckley ◽  
S. Bigham ◽  
V. Nangalia
Keyword(s):  
Infectious Disease ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
In Situ Simulation ◽  
Operational Readiness

scholarly journals Recent advances in laryngoscopy in adults

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 797 ◽  
Author(s):  
Matteo Parotto ◽  
Richard Cooper
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Patient Safety ◽  
Intensive Care ◽  
Tracheal Intubation ◽  
Direct Laryngoscopy ◽  
Line Of Sight ◽  
Clinical Settings ◽  
Care Providers ◽  
Recent Advances

Recent advances in technology have made laryngoscopy less dependent upon a direct line of sight to achieve tracheal intubation. Whether these new devices are useful tools capable of increasing patient safety depends upon when and how they are used. We briefly consider the challenges in reviewing the emerging literature given the variety of devices, “experience” of the care providers, the clinical settings, and the definitions of outcome. We examine some of the limitations of conventional direct laryngoscopy, question the definitions we have used to define success, discuss the benefits of indirect (video) techniques, and review evidence pertaining to their use in the patients in the operating room, emergency department, and intensive care unit.

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