Board 279 - Program Innovations Abstract Improving Attention and Compliance with Risk Prevention Strategies through Simulated Error Experiences (Submission #325)

Abstract

Introduction/Background Following personal experience with errors, providers anecdotally report a greater sensitivity to risks. Research has shown that the greater the perceived consequences associated with missed detection of an event, the higher the likelihood that the event will be detected1. Higher perceived consequences are associated with greater adoption of prevention strategies2. We are developing an innovative program to manipulate attitudes and behaviors related to compliance and attention to risk reduction strategies through simulations that expose nurses to embedded error situations. Methods We expect certain characteristics of simulated error experiences to influence how participants perceive and internalize the experience. We developed nursing simulation scenarios involving embedded errors in the context of routine tasks. We varied patient type (adult and pediatric), type of error (flow rate error, wrong fluid error, mis-stocked, wrong concentration or wrong route medications and allergy contraindicated order error), number of errors and whether the participant acted alone or on a team. Seventeen nursing students and five practicing nurses completed the simulations in laboratories. We surveyed participants’ perceived realism and perceived changes in attitudes regarding error likelihood, consequences and error prevention behaviors. We also solicited qualitative input regarding factors that influence whether the simulation experience provides a lasting impact on patient safety risk perception attitudes and behaviors. Table 1 presents a subset of survey response Results. Among six participants who completed the scenarios in teams, the mean score for the memorability question was 7.2 while the mean score for sixteen participants who worked alone was 8.3. Most, if not all, participants failed to identify and appropriately manage at least one embedded error during the experience. In post-simulation debriefings, participants believed that completing two scenarios (compared to one) added to the impact of the experience by providing exposure to different types of errors in a way that supported generalization of the experience. Participants also perceived value in reading real life stories of errors, particularly those involving severe patient harm, in conjunction with the simulations. Nurses commented that they believed a continuing program of error simulations every six months to one year would positively impact their ability to detect and mitigate error situations. Whether or not investigators were open or guarded in their description of the goals of the simulations did not appear to impact participants’ perception of the experience. Embedding more than one error in a single scenario was not perceived as unrealistic. Participants perceived the simulation experience to have a greater impact on their perception of patient safety risk than other forms of error education they received.Results: Conclusion Our findings support continued development of programs to expose nursing students and RNs to error situations for maintaining awareness of risk and the need for risk prevention practices. The next stage of our program development involves evaluation of in-situ scenarios that realistically integrate use of healthcare information technology and barcode medication administration systems. We also plan to conduct formal research to evaluate the impact of a program of error simulations on error rates in inpatient nursing units.