PG99 Using an in-situ multidisciplinary simulation program to highlight latent errors in theatres. (10th November 2020)

• Record Type: Journal Article
• Authors: Liu, Lucy; John, Sini; David, Lydia; Dimmock, Val
• Is Part Of: BMJ simulation & technology enhanced learning. Volume 6(2020)Supplement 1
• Page Start: A87
• Page End: A87
• Publication Date: 2020-11-10
• Subjects: Medicine -- Simulation methods -- Periodicals; Medical innovations -- Periodicals; 610.113
• DOI: 10.1136/bmjstel-2020-aspihconf.147
• Languages: English
• ISSNs: 2056-6697

Abstract

Abstract : Introduction: Simulation is a powerful tool used in healthcare to improve clinical practice and in-situ simulation, in particular, can be used to identify latent errors within a particular department. 1 Although anaesthetists recognise its importance, simulations often involve anaesthetists only and take place within dedicated high fidelity simulation suites. We initiated a program of multi-disciplinary in-situ simulations in the theatre department of a London hospital over six months for theatre, recovery and anaesthetic staff. Methods: At Homerton Hospital, theatres are run in two distinct areas – six main operating theatres in one building and three day-surgery theatres in another. We ran bi-monthly simulations alternating between main theatres and the day stay unit at times convenient to the lead nurse and the anaesthetic college tutor. We used feedback sheets mapped to the RCOA curriculum to identify learning gaps for staff. We used a mannequin or an actor as the patient, and iSIM technology to mimic and change bedside observations depending on the actions of the participant. If we had permission, we would use any additional equipment found in their normal working environment. The simulation for the participants including debrief lasted an hour in total, although the whole process took longer to set up and replace all equipment. We ran nine simulations before terminating due to the COVID-19 pandemic. Results: We identified several safety threats during the process including deficiencies in clinical knowledge and lack of availability of emergency drugs or equipment. We have been able to implement improvements based on our findings and this has led to the purchase of a fridge for the storage of emergency medications, and the implementation of a new fire protocol for theatres. Overall feedback from participants and from clinical leads was very good, and we used the RCOA curriculum and feedback forms to guide us in creating relevant simulation scenarios. More extensive results can be presented at the conference. Discussion: In-situ simulation allows clinicians to rehearse in their normal working environment and supports MDT learning alongside familiar colleagues. This has the advantage of highlighting latent errors in systems performance that would not have occurred in a dedicated simulation suite, and reveals potential errors before patient safety is compromised. Although the programme was terminated earlier than anticipated due to the ongoing pandemic, we are hopeful that it will resume soon under the leadership of the next simulation fellow. Reference: Lamberta M, Aghera A. Latent Safety Threat Identification via Medical Simulation. [Updated 2019 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549909/