Background In-situ simulation is an evolving area, providing a platform to identify potential hazards and deficiencies in clinical systems.1 Feedback from our anaesthetic trainees consistently detailed the poor availability of drugs for paediatric emergencies. Additionally, they were unaware of the ‘stabilisation room’ on the paediatric ward.
We aim to assess the stabilisation room on the paediatric ward as a safe environment for critically ill children, identify system issues or latent threats to patient safety, and assess a case for paediatric ‘grab bags’: emergency drugs bags that conform to South Thames Retrieval Service (STRS) guidelines.2
Methods A multidisciplinary simulation session was performed in the stabilisation room on the paediatric ward with current employees. No adjustment of the equipment or room was made to enable testing of the existing facilities and identify barriers to acquiring equipment. The clinical scenario: a male infant with severe bronchiolitis requiring retrieval to a paediatric intensive care unit (PICU). A time line was documented detailing goals set, time goal achieved, and limiting factors.
Outcomes The time from decision to intubate until intubation achieved was 28 min 45 s. The delay was multi-factorial: the acquisition of STRS recommended drugs; the team unfamiliar with ventilator in the room; the inability to locate equipment in the airway trolley. A physical barrier also interfered with access to the patient: the position of the existing monitor. This was also inaccessible to the anaesthetist.
Recommendations We have presented a business case for the introduction of paediatric emergency grab bags to expedite intubation once this decision has been made. Additionally we have identified a training gap in the use of the current ventilator, and expressed the need for a standardised airway trolley, maintained by the anaesthetic department. Lastly, the ergonomics of the stabilisation room need addressed to improve access to the patient.
Henriksen K, Battles JB, Keyes MA, et al., eds. Advances in patient safety: new directions and alternative approaches (Vol. 3: Performance and Tools). Rockville (MD): Agency for Healthcare Research and Quality (US), 2008. Available from: http://www.ncbi.nlm.nih.gov/books/NBK43665/
strs.nhs.uk (2015) Retrieved 27 May 2015 from http://www.strs.nhs.uk/educationandguidelines/guidelines.aspx
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