makes it all worthwhile

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There is plenty of work in setting up a simulation series for your workplace – however the encouragement like this is well worth it!  This is from an IUD placement/cervical shock simulation run two weeks ago.

 

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The very small team

 

While writing a scenario for cervical shock during IUD placement, I reflected on that very small team – the patient, doctor and one nurse.  This is often present during smaller procedures compared to the larger team for something like a procedural sedation.  Thinking then about the objectives for the scenario often being around early recognition of an event and BLS – in this case pallor, sweating, bradycardia, only those two people present benefit from the problem recognition phase.  Hopefully then the button is pressed, help arrives and other useful lessons are used – shared mental model, team leader selection, clear communication.  Is there a role for having the other participants in the room for that first recognition of collapse so they can imagine what they would do next?  This is used with the Tag Team Patient Safety Simulation for CQ University. Or is it better to reflect daily practice and have your other adhoc members off in their own rooms, awaiting the emergency call?

Better Sim Cases – a SimPodcast reflection

In episode eleven, Victoria Brazil and Jesse Spur are joined by Kyla Caners from Emsim cases who’s templates at EMsimcases I have mentioned before.  There were a couple of great reflections for me in this podcast – around ensuring objectives are present for all the disparate members of the team and the point that a team does not need to solve the case.  By not solving the case, the team may have to work all the way through an algorithm and focus on ensuring basics are covered well.

Flowcharts, tickboxes and more

Expanding on the idea of improving my focus as the sim provider on measurable objectives, I have been thinking about how I write scenarios and looking at how others do it. I recently came across two disparate but well done examples.  the flowchart idea is from the Oxford Deanery simulation scenarios, using flow charts to give options about how easy to hard the scenario progresses to.

conductScenarioOxfordDeanery

The other detailed tickbox approach which uses an internal cascade of modifiers and triggers is from emsimcases.  Is this approach too cluttered – the OCD part of me likes the many tickboxes to ensure I am assessing objectives as ways of measuring progress towards the goals of the simulation. This is a link to their blank template.

emsim

Encouragingly both of these cases are available as a creative commons licence – great work FOAMed teams!

 

Objectives in scenarios

With a recent scenario we realised in debrief that we are not using PPE.  Participants are not putting on gloves or glasses before engaging in the scenario.  I then realised on reflection that as the sim provider, I am not identifying this in the scenario and the reason I am not identifying this is poor creation of objectives in the sim scenario.  Goals are the attainable, relevant aims for the scenario. Objectives are the measurable items that confirm the goals are being attained.  I have also seen this called “expected care”, such as in this template for scenario design from SMACC Chicago 2015. gant-nitrile

This then flows onto other items in the scenario, time to CPR, time to AED, checking pad contact and other markers of quality care.  Especially as an occasional sim provider,  creation of checklists in the scenario writing should help me ensure we are actually meeting goals and then objectives.

In scenarios from the simtech, objectives are further broken down into Knowledge/Skills/Attitude & Behaviours.  This seems like a great approach however a significant ramp up in being able to observe and record this all across a scenario.

Thinking about this more overnight, I also need to bring in different objectives for different members of the team.  Being medical, this is my focus however integration with goals/objectives for reception and nursing would make this work more applicable to them and hopefully foster engagement.

in situ simulation as orientation

One powerful facet of in situ simulation that self-evidently cannot be done elsewhere is orientation to a new practice/clinic. Today I was covering foreign body removal with the two new registrars who have just rotated in to our clinic one week ago.

Rather than collect all the items needed for the tutorial myself,  it is more useful for them to find the eye box, loupe, amethocaine, flouroscein and bring them to the room. Then run through the examination, foreign body removal and disposition as a short scenario with a debrief. Now the registrar has had some practice on a task trainer and is orientated to the practice resources.

EyeModel
The eyes in place, last piece of tape about to be applied

The task trainer was made with peeled grape eyes with 100’s & 1000’s (cake sprinkles) as FB that leach out a food colouring “rust ring”.  The grapes were held in place with modelling clay and tape.  The tape has been partially folded back on itself to create an eyelid that can be everted. Ey1