P13 MIsST: Micro In-Situ Simulation Training

Background

In-situ simulation (ISS) has benefits on an organisational level including highlighting patient safety concerns and economical use of resources. For individuals, it negates the need for travel to a simulation centre and enhances team working.¹ However, stakeholders may feel that in-situ education can distract clinical staff thereby reducing efficiency and patient flow. We responded to this by developing a novel tool of ‘micro’ simulation sessions.

Summary of work

In order to create ‘learning in context’ for emergency department (ED) staff, a dynamic team of interprofessional clinical educators developed ‘micro’ ISS. This could be delivered to ED staff without removing them from clinical duty for more than 15 minutes. This allows for rapid education without disruption to departmental flow. Each scenario was adaptable to a multiprofessional team with one-on-one teaching for participants. Scenario flexibility allowed for a balance between debrief, teaching and practical skills. Scenarios were designed in response to near-misses and critical incidents logged via the datix reporting system, responding directly to patient safety concerns.

Summary of results

A package of scenarios was delivered (Management of diabetic emergencies; Phenytoin administration; Trauma/head injury; Sepsis/preparation for transfer; Management of hyperkalaemia; Starting non-invasive ventilation). Key stakeholders from ED, pharmacy, physiotherapy, outreach, intensive care and anaesthetics were involved in the development and delivery of the sessions. 14–25 participants attended every session: a mixture of nurses, doctors (foundation to consultant), health care assistants and students (medical, nursing and physician associates). The interprofessional faculty each taught a diverse group and peer-to-peer learning was encouraged. The scenarios were adaptable to the training needs of the individual. Participants all reported increased confidence levels pre and post-session, their feedback of current learning needs shaped future sessions. Findings from each scenario were collated and a standardised proforma was disseminated to the ED with global learning outcomes and required departmental actions such as equipment orders or change in stock drug concentrations.

Discussion and conclusions

Our programme was well received, allowed for departmental training in addition to addressing patient safety concerns. We have shown that ISS does not require large scale scenarios; targeted clinical skills can be addressed in a ‘micro’ session whilst still allowing overall functioning of a busy ED. Recommendations This model is easily replicable throughout a hospital setting. Key stakeholder involvement as well as an enthusiastic and adaptable clinical education team ensure well managed and received education.

References

Sorensen JL, Ostergaard D, LeBlanc V, Ottesen B, Konge L, Dieckmann P, Van der Vleuten C. 2017.Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation. BMC Med Educ. 17:20.