Aims High fidelity simulation is now well established as a teaching method for the whole multiprofessional healthcare team. In situ simulation allows the team to work through seldom seen scenarios, and make mistakes in a safe environment. It also allows team members to become familiar with each other, and the unit they work in, and uncovers potential problems within those units.
There is no evidence to show that in situ high fidelity simulation training improves clinical outcomes, however the evidence still supports its use. Simulation training has been shown to enhance confidence, improve teamwork and patient safety, and highlight system or equipment failures within a team or clinical area.
In our unit, the SimBaby equipment was available, but was only being used infrequently, and not to its full potential. Therefore, a quality improvement project was set up to undertake regular multidisciplinary in situ high fidelity simulation training in the neonatal unit.
Methods The quality improvement model of ‘plan’, ‘do’, ‘study’, ‘act’, was used and worked through as the project was undertaken.
A group of nursing and medical staff who were keen to become involved were identified. Those with prior experience of simulation training brought their expertise to the project, and most took the opportunity to attend simulation teaching days.
The Simbaby (Laerdal) and resuscitation equipment was set up in an isolation room in the NICU. A ‘GoPro’ video recording device was set up to provide live recordings of the simulations, which can be played back during feedback. Several scenarios were developed, some with the use of the ‘simdesigner’ program.
A questionnaire was devised to ask participants’ opinions about various aspects of the sessions. This is completed prior to the first simulation session, after three, and again after five sessions.
We aim to carry out one simulation session per week, however this can vary depending on the availability of staff, and pressures elsewhere within the unit. At least two registrars or consultants lead each session, with at least one nurse, one registrar and one SHO participating. There is usually also a consultant to participate. There is then a feedback session and an opportunity to go over various aspects of the scenario at the end.
Results Only initial questionnaire results are available, so results are limited, however as simulation sessions are ongoing, more results are available each week. 6 participants have completed an initial questionnaire: 4 SHOs, 1 registrar, and 1 neonatal nurse. 5/6 participants were familiar with simulation training. 2/6 felt confident managing a neonatal airway, and 3/6 were confident with CPR. 1/6 could access the equipment they needed in the unit. 6/6 felt further training was needed, and 6/6 found the video review helpful. 5/6 felt that multidisciplinary simulation was helpful. Uptake on sessions has been excellent when the unit isn’t too busy.
Discussion The lack of confidence in skills probably reflects the fact that most of the sample were SHOs, questioned early in their first paediatric post. However, we feel it also reflected the quality of their departmental induction, and this has lead us to include a simulation session in the next induction process. It is encouraging that everyone was keen for further sessions, and also that most felt that these should include the whole team. We are hopeful that confidence and familiarity with both team members and the relevant equipment will have improved when we have further results.
Overall, our aim is to establish a Northern Ireland Simulation Network in concert with other neonatal and paediatric units in the province. We hope that by sharing our experience and information, this will enhance teaching and performance across Northern Ireland (Figure 1).
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