Board #256 - Program Innovation An Innovative Simulation Program Identifies and Addresses Risks to Patient Safety Among Nursing Students Commencing a Clinical Placement (Submission #9111)

Abstract

Objectives Genuine engagement during a clinical placement offers the students opportunity to link theory to practice and is recognised as a valuable addition to their education curriculum. However, clinical placements can place both students and patients at risk. Consolidation of theory into practice is hampered as there is rarely adequate time or ability for feedback and debriefing. The unpredictable nature of healthcare means students are not guaranteed experiences which will allow them to consolidate theory into practice, and they can become peripheral observers, instead of active participants. Low acuity patients can deteriorate quickly, which students may not be able to detect, or respond to, in an appropriate or timely manner. This program was designed to provide students with a standardised set of cases prior to placement to ensure basic clinical skills were in place and that appropriate responses to deteriorating patients were understood and implemented. The program was particularly innovative in the use of automated feedback to improve inter-rater reliability and to identify individual and group learning needs to the nursing educators. Due to limited resources, the scenarios needed to be able to process large student numbers in a short time with minimal educator resources. Description The program was developed following a needs analysis by the hospital’s education team. Nursing educators were surveyed to identify previous skill gaps that had occurred with nursing students, where the patient or the student was placed at risk. This data was compared with adverse event registries and coroner’s reports. Three short, low cost scenarios were developed based on findings. Both expected and unexpected actions were programmed into the mobile device used to grade the student’s performance. At the completion of each simulation an automatically generated, personalised report was given to each student along with their verbal debrief. Once developed, this method significantly increased the capacity of the simulations and reduced the need for experienced educators. These reports identified areas of clinical strength and weakness among the student cohort, and also provided administrators with evidence of compliance to hospital accreditation standards. A mixed methods approach was used to evaluate the program. Students and nurse educators completed surveys and focus groups to rate the quality and utility of the program.Conclusion The use of adverse event data, to generate the simulations, created situations that the students and educators considered to be relevant, realistic and worthwhile. Using pre-programmed scenarios improved inter-rater reliability and allowed the use of staff previously unfamiliar with simulation to support the program. Pre-populated feedback provided students with a standardised, objective and permanent record of performance that placed no demand on educational staff once developed. The program revealed group learning needs that might otherwise have been missed or mistaken for individual learning needs. Limitations included that the student cohort was dominated by students from one university, which may skew group learning needs. Furthermore, the depth and quality of the written feedback were found to be lacking early in the project and had to be modified significantly during the program. The future aim is to move the electronic assessment tool to the wards to identify if student behaviours observed in simulation are transferred to the workplace. This project has shown that simulation can be used by non-experts to assess gaps, not just consolidate skills. Unlike other simulation programs, we used the safe simulation environment to both identify and address learning needs. Disclosures None