Ongoing staff education and training is key to creating change, ensuring best practice and improving patient care. Within our critical care, we are further challenged by a medical workforce that changes frequently and an influx of new nursing staff (37% new within the last year).
Simulation is a safe, ethical and enjoyable means of education. Importantly, it can encompass a review of essential clinical knowledge and discussion of more complex non-technical skills; which allows us to test our critical care team and debrief crisis resource management issues. By performing mobile/ ‘in-situ’ simulation within the critical care unit – we are also able to test the familiarity with and effectiveness of emergency processes and systems within the Adult Critical Care.
Our overall objective is to improve the safety and quality of care delivered to our critical care patients. Through the vehicle of simulation, the focus was placed on better team working and communication, enhanced clinical skills and knowledge, orientation to the critical care environment and increased familiarity with specialist equipment. A secondary objective is to create an environment where teams can work together to identify and create opportunities for continued learning on-the-job, in the workplace.
This program is in its second year. For the first year, we used national guidance (NAP4, NCEPOD ‘On the right track) and local governance reports to write simulation scenarios based on airway and tracheostomy emergencies. These scenarios close the loop of clinical governance and meet national patient safety recommendations. Using the SimMan Classic on the critical care unit, we ran 12 simulation sessions with three to four scenarios per session over 12 months. This spaced program ensured that all the nursing teams on critical care were exposed this training. All sessions were multi-disciplinary with Intensive care doctors, physiotherapists, health care assistants and technicians also involved. Over 200 staff participated the first year of this program.
Participant feedback was collected and collated thematically. All participants valued the exposure to equipment on the difficult airway trolley, whilst 72% described an improved understanding of the difficult airway algorithm. Candidates identified the importance of effective leadership, role expectations and closed looped communication, valued the opportunity to learn from mistakes and reported a greater understanding of team working (89%). All participants described the sessions as directly relevant to their clinical practice and over half volunteered that such session were ‘essential for patient safety’. From this, we determined that the program helped to increase staff knowledge and embed key emergency airway skills.
Further feedback was sought at 6 months from a sample of participants after their sessions. Only a third of respondents reported being in an airway emergency situation since their training. 74% stated wanting further simulation training on the same topic and 84% wanted further simulation training on a different topic. In contrast to the immediate post-simulation feedback, only 36% of respondents felt that their team working had continued to improve whilst in the day to day work environment, since the simulation training. This 6 month feedback furthers the case for regular simulation training focusing both on team working and clinical skills.
Post simulation debriefs also identified a lack of knowledge and confidence in specific clinical skills by staff members. In response to this and the 6 month feedback, staff have been trained to train others in a new in-house skills training programme. We continue with a second year of simulation training with new scenarios based on airway and other critical care emergencies, with topics identified from the feedback and incident reports.
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