EUSKALDUNA CONFERENCE CENTRE BILBAO, SPAIN, 27-29 JUNE 2018
24th Annual Meeting of THE SOCIETY IN EUROPE FOR SIMULATION APPLIED TO MEDICINE
ABSTRACT BOOK
Accepted for Poster Presentation
A pulmonary-focused simulation-based curriculum for Doctor of Pharmacy students Format: Accepted for Poster Presentation Subject: Curriculum Development Authors Amanda Chichester
University of Rhode Island
Clinton O Chichester III
University of Rhode Island
Introduction & Aims A patient in the ICU is suffering from a protracted asthma exacerbation that is not responding to standard treatment. What drug will be most effective for reversing airway resistance and improving the patient’s oxygenation? How should the drug be administered? As the practice of pharmacy has expanded beyond drug compounding and dispensing advanced practice pharmacists have become a crucial resource for critical care clinicians and patients. As such, pharmacy students must have sufficient opportunity to apply critical care therapeutics in realistic circumstances. Our primary aim was to develop a pulmonary-focused simulation-based curriculum to better prepare our students for the challenges of treating critical care patients. Description We developed this curriculum using the TestChest by AQAI coupled with a 3G simulator by Laerdal. Our decision to develop this curriculum was based upon several factors including the renewed scientific interest of inhalation-based therapeutics as well as improved understanding of the factors that govern effectiveness of inhalation-based therapeutics. These factors have led to an increase in use of inhalation-based therapeutics in highly complex patients on either continuous non-invasive ventilation (NIV) or standard mechanical ventilation (MV). Despite widespread clinical use, recent publications have documented persistent gaps of knowledge that may lead to improper administration and limited efficacy of inhalation-based therapeutics. Our curriculum was designed to close this knowledge gap by creating an opportunity for students to achieve the following objectives: • Identify factors that govern effectiveness of inhalation-based therapeutics • Identify and apply variables that improve efficacy of inhaled therapeutics • Demonstrate techniques that improve efficacy of inhaled therapeutics • Administer an inhalation based treatment to a select patient (simulated patient will be randomly assigned and will be maintained on either continuous non-invasive ventilation (NIV) or standard mechanical ventilation (MV))
Discussion In summary, inhalation-based therapeutics and associated delivery systems are complex. We believe that properly educated critical-care pharmacists could optimize inhaled therapeutics potentially improving patient outcomes. New inhalation-based drug formulations and adjunctive delivery devices are entering the healthcare landscape at a rapid pace. The use of inhalation-based therapeutics will continue to expand creating a greater need for related education for all critical care clinicians. While designed for pharmacy students, we believe our unique curriculum offers an attractive and realistic platform that can be readily adapted for medical or nursing students to put their advancing body of knowledge into practice.
A simulation-based intervention to improve non-technical skills in obstetric surgical teams in a secondary level maternity hospital in South Africa Format: Accepted for Poster Presentation Subject: Patient Safety / Quality Improvement Authors Rowan Duys
Department of Anaesthesia and Perioperative Medicine, University of Cape Town
Tinashe Chandauke
Patient Safety Academy, Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford
Introduction & Aims Perioperative causes of morbidity and mortality form a significant proportion of the unacceptably high maternal and foetal death rates in South Africa. Poor non-technical skills within surgical teams are associated with poor performance but formal team-based non-technical skills training is not offered in this country. We propose a pilot to investigate the feasibility and impact of a simulation-based intervention to improve obstetric surgical team non-technical skills performance as a prelude to further measurement of its effect on patient outcomes and widespread roll-out. The primary outcome measured will be the impact of the intervention on non-technical skills performance in the simulated surgical environment. Secondary outcomes will include learner and facilitator experience, feasibility, and sustainability.
Methods Local ethics board approval has been obtained for a prospective, quasi-experimental, before-and-after design to be deployed targeting the operating theatre staff at a secondary level obstetric hospital in Cape Town, South Africa. Preliminary ethnographic data describing current non-technical skills behaviour in theatre (in analysis phase at present) will inform the intervention design and data collection will proceed from January – April 2018. A low-technology patient-simulator will be deployed in weekly in-situ simulated scenarios of obstetric crises with inter-disciplinary teams as targets. Patient safety attitudes will be assessed pre-intervention with a questionnaire and team performance in the simulated scenarios will be evaluated using the Oxford non-technical skills rating system. Team performance and patient safety attitudes will be re-assessed at the end of the 4-month period and compared for change. Further qualitative data exploring learner and facilitator experience will be gathered using semi-structured interviews analysed thematically. Results & Discussion Preliminary ethnographic data suggest significant contextual challenges to patient safety such as significant language barriers within teams. We hope the simulation-based in-situ interventions will provide exposure to impactful non-technical skills training, but will also facilitate shared learning experiences for members of the inter-disciplinary team that seldom train together. If sustainability can be demonstrated, this will inform the roll-out of future interventions to other surgical teams within Cape Town and to a wide network of hospitals in Southern Africa where the investigators have already established relationships.
Advocating technology enhanced learning to improve systems: Assessing staff competency and efficiency using mobile phones in clinical practice through simulation-based in-situ evaluation. Format: Accepted for Poster Presentation Subject: Patient Safety / Quality Improvement Authors Peter Mallett
Clinical Fellow in Education & Simulation
Carol Junk
APNP, RBHSC
Jennifer Wallace
Paediatric Registrar, RBHSC
Andrew Thompson
Consultant Paediatrician, RBHSC
Introduction & Aims The use of mobile devices by Healthcare professionals has transformed many aspects of clinical practice.1 In our unit, management are currently reluctant to advocate the staff use of mobile phones due to the risks associated with interference of medical equipment, infection control concerns, and reported parental complaints. Mobile devices provide a multitude of benefits for clinical staff including increased access to useful apps such as drug-dose calculators, and other validated point-of-care tools, which are of high educational value and have been shown to support better clinical decision making and improved patient outcomes.2 Description We designed a survey assessing parental and staff perception on the use of mobile phones, using a five point Likert scale. 40 staff and 40 carers participated. We then designed two clinical simulated scenario’s assessing administrator and prescriber performance for healthcare professionals. We assessed length of time to complete task and degree of accuracy. Scenario 1 participants were prohibited from using mobile phones. Subsequently, participants were granted access to mobile phones for assistance in Scenario 2. 38/40 (95%) parents surveyed felt that healthcare professionals should be allowed to use mobile technology in a clinical environment. Similarly, of the 40 staff members surveyed, 39/40 (97%) felt access to mobile phones for clinical reasons was appropriate. For the drug administration simulated scenario (performed by 10 nursing staff), all participants were quicker using mobile phone for assistance. The average length of time was 1 minute 22 seconds quicker. Task accuracy was maintained at 100% with and without mobile phone use. For the prescriber simulated scenario (performed by 9 medics and 1 non-medical prescriber), again all participants were quicker using mobile phone aide, with an average length of 1 minute 26 seconds quicker. Accuracy of 100% was maintained in both cohorts. Discussion Despite previous suggestions of parental concerns, this survey highlights the strong carer support for healthcare professionals appropriately using mobile phones in clinical areas within this unit. Staff members were similarly keen for
the use of mobile technology to aid their practice . Through the use of In-situ simulated clinical prescribing and administration scenarios, we have demonstrated an improvement in efficiency of performing clinical tasks with the assistance of mobile phones, ensuring accuracy was maintained. We plan to negotiate with senior hospital management team, using this initiative as evidence, in a bid to demonstrate that the appropriate use of mobile phones in a clinical setting promotes well-informed, safety-conscious, technology-assisted effective clinical care. Download: Download figure/table
After action review: Bridging the gap Format: Accepted for Poster Presentation Subject: Patient Safety / Quality Improvement Authors Dr Mary Salama
Birmingham Children’s Hospital
Dr Fozia Roked
Birmingham Children’s Hospital
Introduction & Aims Simulation is a tool that is widely used in a variety of settings to teach both technical and non technical skills. There has been evidence of the minimal impact that increased fidelity has on the transfer of learning (Ref1). We noted that there were many examples of similar learning points which could be gained within the normal working day. Our team covers a general paediatric caseload within a specialist paediatric hospital. Our patients can vary from an average of 50 to over 100 spread across up to 15 wards and is made up of 30 people of differing experience and with variable training needs. Our aim was to introduce a tool to enable us to learn from daily events. Description We introduced the concept of 'A brief 5 minute' board (fig 1). We paired this with the use of the After Action Review (AAR) model of debrief as a daily debriefing tool to maximise learning. Initially this was only done on alternate weeks and showed improvements in learning events, perceived situational awareness and team morale. We subsequently established it as a business as usual capturing data on team preparedness and learning following the debrief. Themes for learning were largely centred around communication both within the team and with parents, team organisation and planning and feedback with regard to wider process issues. We are further adapting it in response to feedback. Discussion After action review provides a mechanism for debriefing around both non-technical skills, systems and processes and teamwork. It provides a forum to discuss factors influencing the effectiveness of an individual and a team in a safe environment. AAR is a tool developed by the military and used across a variety of disciplines. Within the UK health service it has been championed for use following incidents both positive and negative (Ref 2). We have found that within our team, its daily use bridges the gap between learning from incidents or excellence at an extreme towards learning from the daily events. These learning points within human factors or systems processes could easily constitute one hole in the swiss cheese model of adverse events. We would like to thank Dr Phil Debenham and the AAR training team at University College London. Ref1: Norman G, Dore K, Grierson L;The minimal relationship between simulation fidelity and transfer of learning; Medical Education May 2012 Ref 2: Dr Claire Gerada: Trust me, I'm a leader NHS Confederation 2013
Download: Download figure/table
An investigation of paramedic students’ confidence in and satisfaction with clinical simulations of an Emergency Medical Care programme in South Africa Format: Accepted for Poster Presentation Subject: Curriculum Development Authors John Meyer
Cape Peninsula University of Technology : Emergency Medical Sciences
Dr. Kevin Governder
Durban University Of Technology : Emergency Medical Sciences Department
Introduction & Aims In South Africa, the pre-hospital field has various levels of practitioners who provide help to the sick or critically ill or injured persons. Historically, South Africa had three levels of short care courses: Basic Ambulance Assistant (BAA)-a-three weeks’ course, Ambulance Emergency Attended (AEA)-a-six weeks’ course and Critical Care Assistant (CCA) a-six-month course The Universities of Technology and Further Education and Training (FET) colleges in South Africa are the only institutions of learning that can offer these courses. As part of the Emergency Medical Care programme, students are exposed extensively to clinical simulations events before engaging with real patients. These simulations events are usually used for teaching new skills or as an assessment tool to establish if students are ready for clinical practice on real patients. Currently, in South Africa, many health science programmes are using simulations as a teaching and learning tool. But there is limited research on the use of standard measurement tools to assess the benefits of simulation in relation to paramedic students’ self-confidence toward proficiencies and satisfaction with simulation experiences. The study aims to describe paramedic student’s self-confidence in and satisfaction with simulations of an Emergency Medical Care programme in South Africa.
Description There is currently limited research on the use of standard measurement tools to assess the benefits of simulation in relation to paramedic students’ self-confidence, proficiencies and satisfaction with simulation experiences in South Africa . This study would add to the body of knowledge in this subject area. Its outcome will assist paramedic educators in constructing or developing effective learning environments, which in turn will enhance the success rate of paramedic students in the context of achievement of learning outcomes, and enhancement of skills and knowledge of simulation. This study will be utilizing the National League for Nursing simulation framework developed by Jeffries. The framework is based on constructivism, which is consistent with adult learning theories. Constructivism is an active approach that places students at the centre of the learning environment and respects their needs, strategies, and styles, which emphasis on integrated and conceptual learning. Discussion The researcher has completed data collection and will have results at the conference.
Analysis of the educational impact with the use of simulation in the triage process Format: Accepted for Poster Presentation Subject: Patient Safety / Quality Improvement Authors Estrella Martínez Segura
Hospital Tortosa Verge de la Cinta
Elsa Pla Canalda
Hospital Tortosa Verge de la Cinta
Introduction & Aims The first contact of the patients with health professionals at the hospital in Emergency Services corresponds to nurses. What we know as a triage, tends to define as reception, wellcome and classification. Nurses who carry out this assessment must have the competencies to priorize and order the patients effectively based on their problems, manifestation, human responses and neeeds, expressed by the patient and family, and adapt them to the structure of the Emergency service. training plays a key role in the adquisition of these competencies. This study designs, implements and analyses a training intervention where the clinical simulation is used to see if this action improves the nursing competencies in triage and the triage process. AIM: Analyze the use of the simulation in the training of the triage nurses. Methods - Study carried out during the months of January-November 2016. - Design and analysis of a training intervention for nursing triage using the clinical simulation with clinical scenarios, focal groups and observation. A pre-test and post-test about clinical cases in triage is administered to determine the level of knowledge on triage and an evaluation questionnaire of competences (COM_VA). Place: Emergency service of Hospital Verge de la Cinta Tortosa (HTVC).
Results & Discussion The training intervention was effective because it improves the level of professional competence, the time of attention to the triage and the whole triage process in general. The time of entry vs. triage was reduced from 12.41 minutes to 9.88 minutes. We also improved the times in handover . There are significant post-formation differences in aspects such as: the adjustment of the level of triage (p 3,5), 36 items are evaluated as important (between 3 and 3,5), and 9 items are evaluated as less important (
