PP6 Using fully immersive simulation to practice recognising and treating the deteriorating patient

Abstract

Background The recognition and management of acutely unwell patients is a major cause of anxiety for newly qualified medical professionals.1 Nurses and Junior Doctors are often first responders to deteriorating patients and as such it is critically important, they are equipped with the appropriate skills and knowledge to assess, treat, and escalate patients in a safe and structured manner. Previously work within our institution2 has indicated improved confidence to manage deteriorating patients, amongst doctors, through high fidelity simulation training. We describe a one day fully immersive high-fidelity simulation course designed to practice the management of the deteriorating patient. Summary of Work Candidates undertook six scenarios, themed around NHS England never events and local trust serious untoward incidents (SUI’s), in the context of the deteriorating patient. These were based in a high-fidelity simulation centre reproduced as a monitored bay on an Acute Medical Unit, with non-participating delegates spectating each scenario via live stream. A video assisted debrief followed each scenario led by a human factors’ expert. Candidates completed a pre and post course questionnaire. An unpaired (two-tail) t-test was used to analyse quantitative measurements from participant confidence scores and free text responses were assessed using thematic analysis. Summary of results Our course was undertaken by 98 candidates (51 nurses and 31 doctors) and 86 (87.8%) completed a post-course questionnaire. There were statistically significant differences in confidence scores before and after the course in leadership, assessment of acutely unwell patients, management and situational awareness. Thematic analysis indicated course strengths including: utilising a multidisciplinary delegate approach, realism & variety of scenarios undertaken & reinforcement of knowledge and safe clinical practice through the debriefing process, with subject matter experts. Discussion and Conclusions; Recommendations Theming scenarios around never events and SUI’s promotes education & learning from historical error. Our one day fully immersive high-fidelity simulation course demonstrated a perceived improvement in confidence in assessing acutely unwell patients and in assuming a leadership role within the clinical team as well as handover of care. The course demonstrated perceived improvements in key non-technical skills such as situational awareness, management and teamworking skills of particular importance for first responders to deteriorating patients in a ward setting. This adaptive course recommends and actively encourages learning from historical error, by theming scenarios around never events and SUI’s, in order to reduce risk of future recurrence to promote increased patient safety. References Monrouxe LV, Bullock A, Gormley G, Kaufhold K, Kelly N, Roberts CE, et al. New graduate doctors’ preparedness for practice: a multistakeholder, multicentre narrative study. BMJ Open. 2018; 8: e023146. Taylor J, Mercer SJ. Fully immersive simulation improves confidence in dealing with a tracheostomy emergency in junior medical and nursing staff. European Journal of Anaesthesiology. 2016; 33(eS54): 486.