Peri-operative Simulation Training Prior to Opening a New Hospital: Can it Improve Quality and Patient Safety? A Pilot Study

Abstract

Introduction: The report from the National Academy of Sciences’ Institute of Medicine cited studies showing between 44,000 and 98,000 people die each year because of mistakes by medical professionals. Our hospital system and many others in the United States have taken a proactive stance to improve quality and eliminate many of these errors. The Leapfrog Group has created a new initiative based on the National Quality Forum’s (NQF) Safe Practices for Better Healthcare: A Consensus Report. The Consensus Report endorsed 30 practices that should be universally used in applicable clinical care settings to reduce the risk of harm to patients. Methods: Our multidisciplinary study group has developed three peri-operative scenarios: one preoperative, one operative, and one postoperative. Each scenario will include the concepts of safety using ten National Quality Forum Safety Practices which are directly applicable to peri-operative nurses (e.g., verbal orders should be recorded whenever possible and immediately read back, use standardized abbreviations and dose designations, implement standardized protocols to prevent wrong-site or wrong patient procedures). All newly hired peri-operative nurses will be recruited to undergo the simulation training and testing during the period from hospital facility opening until the time of actual patient care. Participation will be voluntary and in addition to their existing preclinical training. Before beginning any training, all participants will complete a questionnaire assessing NQF Safe Practices knowledge. The simulator scenarios will be run with peri-operative nurses participating in their own work environment. Participants will again complete the questionnaire assessing NQF Safe Practices knowledge in the 2–7 days immediately after the simulation training. Further, the hospital system routinely administers Safety Culture Climate tool to all clinical employees for quality assurance measures. We will administer the tool in the week before simulation training, during the 2–7 days immediately following simulation training, and again at two, eight, and fourteen months after beginning patient care. Results: We have developed standard peri-operative human simulation scenarios that can be utilized to train and test peri-operative healthcare nurses with regard to adherence to National Quality Forum Safe Practices. We have gathered preliminary evidence to determine if our peri-operative nurse human simulation training improves implementation of and adherence to the NQF Safe Practices. We have performed a short-term assessment of adherence to NQF Safe Practices by comparing the NQF Safe Practices knowledge of newly hired perioperative nurses both pre- and post-simulator training. This short-term data will be presented at the meeting. In the long term, we will track average perioperative nurse safety culture scores as progress over the following time points: pre-simulation training, immediately post-simulation training, and 2, 8, and 14 months after beginning patient care. Conclusion: Together, the short-term and long-term assessments will serve as pilot data to support the development of hospital-wide simulator training protocols. Conflict of Interest: Authors indicated they have nothing to disclose.