Introduction In situ simulation helps in identification of latent errors1 (potential hazards in the system) and knowledge gaps thus contributing to patient safety. There is the potential for latent risks in newly established facilities that may only get highlighted on the actual running of the department. However, using in situ simulation we can detect these earlier, so that they can be rectified. In situ activity was performed in our newly opened emergency paediatric resuscitation room. We present the outcome of this activity: the latent risks and knowledge gaps identified.
Methods We ran a scenario based around management of status epilepticus in the paediatric emergency department. 6 participants from anaesthesia, paediatrics, nursing, and emergency care were involved. Video recording was performed and shown live in a viewing room adjacent to the emergency department. Video debriefing was performed immediately post simulation. The participants completed a pre and post simulation questionnaire. The latent risks highlighted were graded using NPSA risk matrix2 and recommendations were made to resolve the issues. Debriefing focused on strategies to overcome knowledge issues.
Results One latent risk was identified regarding inadequate management of hypoglycaemia, and this was highlighted and graded according to NPSA risk matrix. Immediate feedback was provided using video debriefing. No equipment or environment issues were noted. Knowledge deficits were effectively highlighted in 4 participants, and 5 participants identified areas of improvement in individual and team performance.
Impact on practice Reassuringly, no equipment or environment issues were noted during the management of an emergency exercise. The plan is to repeat the exercise every month utilising different scenarios to continuously assess the facility. Although we have conducted only one session, we feel quite confident that in situ activity could be a useful in evaluating a new facility in addition to other safety measures.
Patterson MD, Geis GL, Falcone RA, et al. In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf. 2013;22(6):468–77
National Patient Safety Agency. A risk matrix for risk managers. NHS, 2008
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