Improving In-Hospital Falls Management Through In-situ Simulation (2024)

Type of publication:

Conference abstract

Author(s):

*Claire Swindell, *Omar Hassouba

Citation:

Journal of Healthcare Simulation 2024;4(Suppl 1):A1–A102

Abstract:

Introduction: This quality improvement initiative focuses on utilising in-situ simulation techniques to promote active participation from the multidisciplinary healthcare team to improve in-patient falls management. The project focused on a simulated patient that had sustained a fractured neck of Femur after experiencing a fall on the ward. Safe transfer of the fallen patient and identification of equipment needed was central to the project’s objectives. In doing so, learner centred engagement assisted in the identification of organisational and systematic barriers that impinge on best practice. As in-situ simulation can proactively identify latent system issues that may be acting as barriers in achieving best practice, how effective can it be in improving staff management, in response to a fallen in-patient that has sustained a Fractured neck of Femur? Methods: A collaborative approach was initiated and fostered to allow key stakeholders to identify fall-related issues and areas most in need of improvement within the Trust relating to falls. Using in-situ simulation, a standardised patient was utilised to recreate a realistic scenario, where a patient falls on the way to the toilet. The standardised patient ‘role plays’ that they have sustained a hip injury which presents as a fractured neck of femur, hence unable to get up from the floor. The multidisciplinary ward team were then observed to see how they collectively managed the fallen patient and how they safely transfer the patient from the floor. A protected, inclusive debrief was then carried out to enhance understanding of the scenario undertaken and to highlight barriers encountered. Results: Although the multidisciplinary team appeared to have a good awareness of Trust policy and procedure pertaining to post-fall care, accessibility to essential equipment needed was lacking. A need for staff training in the safe use of this essential equipment was apparent. Discussion: By carrying out this immersive in-situ simulation, specific ward issues that required attention were identified, problems that may have gone unnoticed if not presented in a realistic scenario, recreating real-time patient care needs. Therefore, in-situ simulation is an ideal and effective modality in capturing authentic latent issues that may occur during the management of a fallen patient that has sustained a fractured neck of femur. The need for improvements were identified and cascaded to the relevant teams to remove barriers for best practice.

Link to PDF poster

Evolving to Involve: Transforming Observing Learners into Active Participants (2024)

Type of publication:

Poster presentation

Author(s):

*Dr Amy Ingham Farrow; *Dr Emily Thorley

Citation:

Journal of Healthcare Simulation 2024;4(Suppl 1):A67

Abstract:

Introduction:
As an educational modality, simulation “can improve the quality and impact of training provided to doctors now and in the future” [1] but is labour and time intensive due to the small group sizes required to achieve maximum efficacy [2]. Foundation doctors currently undertake two and a half days of multidisciplinary simulation, with scenarios constructively aligned to their curriculum [3]. The need for additional simulation opportunities that are accessible to larger groups of doctors was identified. These sessions would require a more efficient style of delivery to ensure the engagement of all participants, not just those selected to enter the simulation environment. Could the use of multi-modal teaching transform observing learners into active participants to reach a larger audience?

Methods:
The three-part session was designed as an immersive simulation with an integrated interactive prescribing tutorial. This targeted the acute management of a patient with diabetic ketoacidosis and the following twelve hours of their care. The tutorial tasked all attendees (not just those involved in the simulation) with using the Trust protocol to prescribe appropriate treatment at various intervals in response to simulated clinical findings.

Pre- and post-intervention questionnaires explored participants’ views on styles of teaching and examined any changes in clinical confidence and perceptions around the multi-modal teaching style.

Results:
Responses were collected from sixteen Foundation Year 2 doctors who attended the two-hour training afternoon as part of their teaching programme. Data indicated an increase in numbers who agreed or strongly agreed that actively watching scenarios was as valuable as taking part themselves. Additionally, doctors were more confident prescribing treatments based on Trust protocols and were more comfortable using Trust guidelines to manage an unwell patient. Naturally, some challenges arose, with minor changes needed before we repeat this with Foundation Year 1 doctors.

Discussion:
There is huge scope for development of scenarios that integrate different teaching methodologies into simulation-based training. The success of this session has confirmed that, in addition to actively involving larger numbers of participants, a multi-modal teaching style can provide an enhanced opportunity for participants to follow the management of a patient over a longer period than is ordinarily afforded by established simulation formats. It also highlighted the value of this approach in provision of responsive teaching to address prescribing safety incidents. The potential for designing scenarios which allow incorporation of clinical skills using task-trainers is also an exciting possibility.

References:
1. Purva M, Fent G, Prakash A. Enhancing UK Core Medical Training through simulation-based education: an evidence-based approach A report from the joint JRCPTB/HEE Expert Group on Simulation in Core Medical Training [Internet]. 2016. Available from: https://www.jrcptb.org.uk/sites/default/files/HEE_Report_FINAL.pdf

2. Au ML, Tong LK, Li YY, Ng WI, Wang SC. Impact of scenario validity and group size on learning outcomes in high-fidelity simulation: A systematics review and meta-analysis. Nurse Education Today. 2023 Feb;121:105705.

3. UK Foundation Programme. UK Foundation Programme Curriculum 2021 [Internet]. 2021 May [cited 2024 Feb 28]. Available from: https://healtheducationengland.sharepoint.com/sites/UKFPOT/WebDocs/Forms/AllItems.aspx?id=%2Fsites%2FUKFPOT%2FWebDocs%2F4%2E%20Curriculum%2FUKFP%20Curriculum%202021%5FOct22%20update%2Epdf&parent=%2Fsites%2FUKFPOT%2FWebDocs%2F4%2E%20Curriculum&p=true&ga=1

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