12 High frequency in situ simulation education programme – improving delivery of community acquired pneumonia care bundle in the emergency department

Abstract

In order to address compliance with the Trust community acquired pneumonia (CAP) care bundle a simulation based education programme was rolled out in the Emergency Department (ED). A pre-programme audit was performed, followed by an 8 week programme of in situ scenarios using staff on duty in the department. A concurrent audit of compliance with the treatment bundles in 15 real patients (120 patients total) admitted with CAP per week was conducted during the programme and sustained performance through the Trust weekly CAP performance audits. Over the course of the project despite average time to be seen increasing in line with Emergency department attendance numbers by 59% the average time to administration of antibiotics from point of recognition reduced by 39% (mean 112 minutes to 68 minute). The compliance with Trust antibiotics policy improved from 53% to 100% at week 8. The result was sustained despite junior doctor rotations and was recognised as a change of culture within our nursing staff to prompt the doctors to initiate the bundle from triage. Compliance with oxygen prescription was unchanged from start to end point however an incidental results demonstrated effect of visual prompts. During a “clean wall” campaign the A4 oxygen prescription prompts were removed coinciding with a reduction in compliance from 60% to 12%, on reinstatement of the prompts in week 4 of the programme this returned to 66% compliance. There was variability in the compliance with the one hour severe sepsis bundle with the Foundation Doctor four monthly rotations, there was a 74% reduction in time to antibiotics from recognition in severe sepsis with an average time of 23 minutes at week 6, however this was not sustained after the junior doctor rotation on week 7. The ED remained the most compliant area over the following 9 months.