Using Simulation to Improve Safety

By Darlene Self

Dr. Boudreaux and Ms. Andrews, along with colleagues at the University of Texas Medical Branch (UTMB) in Galveston, designed and conducted a large-scale simulation aimed at improving patient safety. A high fidelity patient mannequin, a standardized patient (SP), medical equipment, realistic props, multimedia equipment, and several full scale mock hospital rooms were utilized in the multiphasic simulation. Issues associated with the functionality of the new hospital’s design as well as the presence of latent environmental threats were identified as a result of this collaborative effort. Because this activity occurred before construction was complete, formulating appropriate design and structural changes were more feasible. Thus, they achieved their goal of creating a safe environment for patients.

Dr. Boudreaux and Ms. Andrews submitted an abstract of their project to the 2014 International Meeting on Simulation in Healthcare. Their abstract was not only accepted, but they were invited to sit on an expert panel at the conference. (Conference Session Title – Improving patient safety: Using simulation to test new clinical units) The abstract was also accepted as a podium presentation at the 2014 University of Texas System Innovations in Healthcare Education and INASCL (International Nursing Association for Clinical Simulation and Learning). A brief summary of their abstract is provided below.

Determine the effectiveness, functionality, project design inadequacies and potential for latent environmental threats to patient safety using simulation in proposed full size mock up hospital rooms before the walls are built

Short Title: Testing Patient Spaces Before the walls are built

Bill Boudreaux, EdD, RN1 and Valerie Andrews, MSN2

1OFFICE OF CLINICAL SIMULATION, THE UNIVERSITY OF TEXAS MEDICAL BRANCH, GALVESTON TX, USA and 2SON/NURSING INTERPROFESSIONAL SIMULATION LAB, THE UNIVERSITY OF TEXAS MEDICAL BRANCH, GALVESTON TX, USA

Abstract Summary:

UTMB Health is currently building a $438 million facility with 310 patient rooms. Therefore, the first component of the project consisted of a realistic simulation exercise to assess the ergonomics of the proposed rooms, identify latent environmental variables that posed threats to patient or staff safety during an emergent situation, and to analyze intra-departmental flow. Thirty-five staff members participated in the activity, which was designed to mimic the events that transpire when a patient is transferred between a medical-surgical room, a surgical intensive-care room (SICU), and an operating room (OR). Mock rooms and elevators were created to imitate those projected by hospital blueprints.

Simulation Scenario

A high fidelity patient mannequin was used to simulate a medical-surgical patient whose condition began to deteriorate. The Rapid Response Team was called; team members cared for the patient until the patient coded. When a code blue was called, the code team responded. The patient was intubated, stabilized, and then a chest x-ray was taken. The patient was transported to the SICU via an elevator. When the patient arrived in the SICU, the endotracheal tube was accidentally dislodged requiring the physician to re-intubate the patient. It was a difficult procedure, so the bronchoscope was used. After the patient was stabilized, he was put on a ventilator and a chest x-ray and EKG were performed. The patient was put on ECMO. Large amounts of blood appeared in the patient’s chest tube and the re-entry cart was brought to the room. Blood was rapidly infused. The physician decided not to open the patient but rather go straight to the OR; this necessitated transport via the elevator. The patient received his operation and then was transported back to the SICU.

Standardized Patient Utilized

While the morning activities were centered on emergency procedures and “what if” scenarios, the events in the afternoon focused on other aspects of the patient’s stay. To make this phase of the simulation as genuine as possible, a standardized patient (SP) assumed the role of the post-op patient. Fifteen students from the schools of nursing, medicine, and respiratory therapy became the caregivers. Working together, the students performed many tasks commonly associated with a post-op patient’s care. For example, they helped the patient perform numerous activities of daily living (ADLs). They transferred the patient via stretcher and wheelchair to various locations, and they assisted with ambulation. Each of these maneuvers contained challenging elements because the patient was still connected to multiple tube and drains as well as a Foley catheter. At the conclusion of this interprofessional collaborative experience, students made many valid comments and suggestions regarding equipment design and placement.

Results

Several aspects of the simulation made it an effective method for evaluating a proposed environment of care. Foremost, it allowed teams of healthcare professionals to provide hands-on simulated care using actual technologies and current work processes.

Secondly, it incorporated a SP in addition to a high fidelity mannequin; therefore, providers were required to demonstrate their interpersonal communication skills as well as clinical skills. Together, these components created lifelike scenarios, which enabled participants to accurately access their ability to provide quality care.

As a result of the simulation, several safety threats, design flaws, and procedural concerns were discovered. Now that these adverse factors have been identified, appropriate steps can be taken to ensure patient care in the new hospital is safe and functional for everyone involved.

Authors’ Biographies:

Dr. Boudreaux has his doctorate in Allied Health Education and Administration from the University of Houston. He is nationally certified as an emergency nurse with TNCC, ACLS, and PALS credentials. He is an active member of the SSIH and ENA. As a medical educator in the Standardized Patient (SP) Program, he utilizes his background in healthcare and education to create live and simulated exercises for medical, nursing, and allied health students.

Ms. Andrews is the Director of the Nursing Interprofessional Simulation Center (NISC) and an Assistant Professor in the School of Nursing.  She has over 7 years of experience in simulation education and has implemented a variety of interprofessional activities. She holds certifications as a healthcare simulation educator (CHSE) through the Society for Simulation in Healthcare (SSH) and as a nurse educator (CNE) through the National League for Nursing. With over 18 years of experience as a registered nurse, Ms. Andrews has worked in a variety of settings that include medical/surgical, respiratory, chemotherapy, home health, and most recently the emergency room. She is a PhD Candidate at the Texas Woman’s University and her dissertation focus is in simulation.

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