The Use of In Situ Simulation Training to Identify Latent Threats
Issue: Latent threats are difficult to identify because, by definition, they are hidden within a hospital system posing risks to patients. Latent threats include; system issues, variable medication concentrations, and knowledge gaps. In situ simulation training is a method in which members of the healthcare team participate in scenarios in the actual patient care setting using resources and equipment from that unit1. In situ simulation training allows for identification of latent threats by practicing low frequency high stress and high risk events in real time.
Project Description: In situ simulation training was performed with multidisciplinary teams in actual patient care settings. The settings consisted of general care areas, the emergency department, burn center, special care nursery, pediatric intensive care unit, and radiology department. Various critical pediatric scenarios using high fidelity simulators were utilized. Facilitators and participants identified latent threats immediately following the simulation during the debriefing.
Results: A total of seventy-five in situ simulation trainings were completed over a twelve month period. One to two simulations were held weekly. Each in situ consisted of one, ten minute simulation scenario, followed by a ten minute debriefing with a multi-disciplinary team. A total of twenty-three latent threats were identified and reported to hospital leadership including: bag-valve-mask not available in patient rooms, PALS and ACLS algorithms not easily accessible, code blue notification did not include room number, and inefficient process to quickly treat an anaphylactic reaction in radiology. A multi-disciplinary committee has recently been formed to address latent threats as they are identified.
Lessons Learned: Although various latent threats were identified, there was no reliable method to address the identified threats within the organization. Since there was not a standard process to deal with the latent threats identified, nine months passed before we were able to resolve issues around availability of bag-valve-mask ventilation in patient rooms. It is essential to develop a process to respond to latent threats identified during in situ simulation training in a timely manner.
Submitters:
Stephanie Estephan BSN, RN, , Akron Children’s Hospital
Lori Ferrara BSN, RN, , Akron Children’s Hospital
Kristine Nagy BSN, RN, , Akron Children’s Hospital
Elizabeth Biddell MD, , Akron Children’s Hospital
Mary Patterson MD, Med, , Akron Children’s Hospital
References:
1Wheeler, D. S., Geis, G., Mack, E. H., LeMaster, T., & Patterson, M. D. (2013). High-reliability emergency response teams in the hospital: improving quality and safety using in situ simulation training. Quality and Safety in Health Care, 0, 1-8.