Training and simulation for patient safety (original) (raw)
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Simulation: A Training Resource for Quality Care and Improving Patient Safety
Nursing - New Perspectives [Working Title]
Patient safety is an ever-present topic in the discussion of educators. It has been 20 years since the publication of To Err Is Human, and there are lessons learned, although there is still much to be done. Healthcare systems are becoming increasingly complex, putting the safety of patients at risk. In this context, there is a greater exposure of healthcare professionals to medical-legal liability issues and to becoming victims of situations that are often preventable. Nurses and medical doctors are especially exposed to these situations, since they are visible during procedures, or do so during the points of greater risk during the patient care process. This chapter will review the contribution provided by the curricular integration of simulation-based education as a tool to train technical and nontechnical issues and how this work can be done for the safety of patients through a standardized training plan, under controlled and evaluated processes. We will discuss how resources and elements allow to perform healthcare interventions in a more safely manner. Finally, we will review the existing literature, some experiences, and the available evidence on this topic.
Using Simulation-Based Training to Improve Patient Safety: What Does It Take?
The Joint Commission Journal on Quality and Patient Safety, 2005
S imulations have been used as early as 1910 as a means to train both persons and teams to reduce errors and improve safety. 1 Commercial aviation and the military have invested heavily in the use of simulation-based training because it offers a realistic, safe, cost-effective, and flexible environment in which to learn the requisite competencies for the job. 2,3 Given its purported success in these areas, the use and application of simulations as a training tool has spread to a number of other domains, such as business, education, and medicine. 4 The focus of this article is on providing researchbased guidelines extracted from the military and commercial aviation communities' experiences in designing and delivering simulation-based training for application in the health care community. Although the popularity of simulation-based training has grown during the past decade, using simulation as a part of training is not a panacea. Our review of the team training literature in health care, which we conducted in 2004, 5 showed, for example, that simulation-based training is used to improve team performance (for example, anesthesia crisis resource management training 6). However, it appeared that simulation-based training programs early on either focused on the engineering component of training (that is, the simulator itself) or took a more balanced approach in which simulation is studied in the context of a learning methodology. 5 For example, in a study conducted by Howard and colleagues, 6 the training program focused more on how trainees use the simulator rather than on how the team should work together to respond to the situation.
IN-SITU SIMULATION: A DIFFERENT APPROACH TO PATIENT SAFETY THROUGH IMMERSIVE TRAINING
Simulation is becoming more and more popular in the field of healthcare education. The main concern for some faculty is knowing how to organise simulation training sessions when there is no simulation centre as they are not yet widely available and their cost is often prohibitive. In medical education, the pedagogic objectives are mainly aimed at improving the quality of care as well as patient safety. To that effect, a mobile training approach whereby simulation-based education is done at the point of care, outside simulation centres, is particularly appropriate. It is usually called “in-situ simulation”. This is an approach that allows training of care providers as a team in their normal working environment. It is particularly useful to observe human factors and train team members in a context that is their real working environment. This immersive training approach can be relatively low cost and enables to identify strengths and weaknesses of a healthcare system. This article reminds readers of the principle of « contextualisation » that is needed for the good implementation of simulation-based education in healthcare while highlighting the advantages, obstacles, and challenges to the development of in-situ simulation in hospitals. The objective is to make clinical simulation accessible to all clinicians for the best interests of the patient. Keywords: clinical simulation, in-situ simulation, continuous medical education, patient safety, teamwork, CPD
Simulation-Based Medical Education
Academic Medicine, 2003
Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and wellbeing. Balancing these 2 needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other highhazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.
Patient Simulation to Safely Enhance Clinical Skills: A Wonderful Bridge between Theory and Practice
As a possible solution to problems concerning health care system safety and resource constraints of clinical experiences, patient simulation is recommended to help prepare students and practicing health care professionals to provide safe care by recreating real-life practice environments. Originally employed in aviation and the military, simulation has radically evolved from plastic body parts in the 1950s to today's computer-based simulators, which are employed in a variety of health care settings to enhance skills for nurses with all levels of experience. Opportunities for clinical simulation continue to grow in the nursing profession and within the Kingston Region to bridge the gap between theory and safe practice. This article reviews the past, current and future uses of patient simulation in health care.
Chapter 45 . Simulator-Based Training and Patient Safety
2001
For a number of years, simulators have been used in aviation, nuclear power, military flight operations and other industries as a training tool and method to assess performance. Their use is nearly universal in high reliability organizations. Recently the use of simulation in medicine has increased markedly, in part due to greater awareness of the importance of patient safety. Defined broadly, a simulator replicates a task environment with sufficient realism to serve a desired purpose. In medical training, simulators can substitute for actual patients and can be as simple as utilizing pigs’ feet to practice suturing, or as complex as virtual reality machines and re-creations of actual clinical environments for surgeons, radiologists and anesthesiologists. In a general sense, they improve patient safety by allowing physicians to become better trained without putting patients at risk. For example, in a randomized controlled trial, Peugnet and colleagues used a virtual reality simulato...
Simulation and patient safety: The use of simulation to enhance patient safety on a systems level
Current Anaesthesia & Critical Care, 2005
Errors in healthcare feature in the 10 leading causes of death. The identification of the sources of such errors and the development of countermeasures whether against errors made by individuals or errors occurring due to latent conditions at system level are the key strategies in tackling this large problem. Simulation-based teaching can make meaningful contributions to this process in many ways and at many levels. At the level of the individual healthcare professional simulated clinical scenarios can raise awareness of the nature of the problem and demonstrate the relevance and need for training in a crew resource management type of course. At the level of an anaesthetic department such courses can help provide a common approach to problems in an area neglected by traditional teaching and so improve communication in this area. The use of simulation also extends to research and development. Study of the use of key resources, such as personnel or equipment, under stressful conditions in a simulated environment can help not only detect possible sources of error but can also help develop strategies to provide effective specific countermeasures.
Collegian
Background: There is unprecedented increase in use of simulation-based education in healthcare settings. The key driver is improving quality and safety in healthcare. To date, there is limited understanding of the degree to which this goal has been achieved. Aim: This scoping review aimed to explore the extent to which simulation-based education in healthcare has addressed and impacted contemporary patient safety priorities. Methods: Systematic searches of literature (2007-2016) were based on each of 10 patient safety priorities articulated in Australia's National Safety and Quality Health Service Standards and New Zealand's Health, Quality and Safety Indicators and markers. Included primary studies evaluated transferability to practice and/or behavioural change and improved patient outcomes, based on Kirkpatrick's training evaluation model Level 3 and Level 4. Findings: Fifteen papers met inclusion criteria. Studies aligned with four of ten National Safety and Quality Health Service Standards: (3). Preventing and controlling healthcare associated infections; (4). Medication safety; (6). Clinical handover; (9). Recognising and responding to clinical deterioration. The studies were indicative of potential for simulation-based education to have a significant impact on patient safety. Discussion: Studies that qualify as translational science, demonstrating changes in clinician behaviours and improved patient outcomes, are emerging. Little evidence from Australian and New Zealand contexts suggests that outcomes of simulation-based education in this region are not commensurate with the significant government investments. Conclusion: Translational studies, despite being difficult to design and conduct, should form part of a thematic, sustained and cumulative program of simulation-based research to identify translational science.
Making a difference for quality of care and patient safety: Research with and about simulation
Globalization and Health, 2010
Simulation is spreading – now also for research purposes In recent years simulation in the health sciences has spread around the world 1. More disciplines and professions are engaging in education and training activities using simulation as an educational tool. We gave an overview about the use of simulation in an earlier issue of this publication 2. In this paper we explore the connections between simulation and research. Our aim is to describe uses of simulation that go beyond the educational use, while at the same time, helping in generating new knowledge that can inform simulation-based education as well as safe care for patients.
BMC medical education, 2017
Simulation-based medical education (SBME) has traditionally been conducted as off-site simulation in simulation centres. Some hospital departments also provide off-site simulation using in-house training room(s) set up for simulation away from the clinical setting, and these activities are called in-house training. In-house training facilities can be part of hospital departments and resemble to some extent simulation centres but often have less technical equipment. In situ simulation, introduced over the past decade, mainly comprises of team-based activities and occurs in patient care units with healthcare professionals in their own working environment. Thus, this intentional blend of simulation and real working environments means that in situ simulation brings simulation to the real working environment and provides training where people work. In situ simulation can be either announced or unannounced, the latter also known as a drill. This article presents and discusses the design o...