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Introduction of in situ simulation in Yorkshire Maternal Emergency Training programme
Abstract Number: F-44
Abstract Type: Original Research
YMET (Yorkshire Maternal Emergency Training) has traditionally utilised drills training in classroom environment. In situ simulation (simulation in the workplace) improves realism and additionally identifies latent errors1 (potential hazards in workplace), which can improve patient safety. Our aim was to improve confidence levels in managing an unwell patient and to identify latent errors to improve patient safety.
In situ simulation was performed on the labour ward using postpartum hemorrhage, pre-eclampsia and maternal cardiac arrest scenarios. 127 candidates participated which included midwives, obstetricians, students, anaesthetists and obstetrics team staff. Participants were given pre-and post-simulation questionnaire to evaluate improvement in confidence levels with regards to managing an emergency patient. Debriefing was performed immediately post scenario. Latent errors highlighted were graded according to NPSA risk matrix and reported to the department with recommendations.
Seventy five latent errors were identified (Non technical 16, technical 7, knowledge 18, training 21, system 13) as shown in figure and reported after grading according to NPSA risk matrix (2). Our results also demonstrate that 70% of the participants felt considerably confident in managing unwell patients, 83% were able to positively figured out changes in there practice that were required to improve individual and team performance and 74% had knowledge gaps amply highlighted by in situ simulation exercise. 94% of the participants rated feedback as very constructive. 87% highly recommended regular simulation sessions.
Impact on practice
Introduction of in situ simulation in YMET training has helped in knowledge enhancement and latent errors identification. Recurring gaps in knowledge are highlighted and are dealt with more focused debriefing. Changes were introduced after recommendations as for example delegates did not realise that perimortem caesarean packs were available on resuscitation trolleys. Therefore a visible yellow sticker is now placed on all trolleys to alert staff to its presence.
1. 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 QualSaf. 2013 Jun;22(6):468-77.
2. National Patient Safety Agency. A risk matrix for risk managers. NHS 2008