Critical Care in the Middle of Nowhere Delivering evidence-based resuscitation in rural Queensland by designing an innovative simulation course. Samuel Brookfield RN South West Hospital & Health Service, Queensland Health

South West Hospital & Health Service Workforce Development Unit

South West Hospital & Health Service Workforce Development Unit

Charleville Hospital 24 beds 24-hr Emergency & Acute Care Maternity Theatre On-call radiographer

SWHHS Nursing Education Basic Life Support Scenario Based Learning Recognising & Responding to the Deteriorating Patient CHEST Course – 2016

Charleville Hospital Emergency Simulation & Training (CHEST) Course 10-week simulation course 2-3 junior doctors, Med Super, 3-5 nursing staff Every Wednesday morning Dual facilitators Nursing facilitator Medical confederate / facilitator 20-30min simulation 1hr debrief

Charleville Hospital Emergency Simulation & Training (CHEST) Course Paediatric pneumonia Anaphylaxis Sick sinus bradycardia – transcutaneous pacing Intentional opioid OD – respiratory arrest Ruptured AAA – PEA arrest Pedestrian vs. Car – pelvic # - I/O access – optional PEA arrest APO with BiPAP Paediatric TCA OD Young adult DKA with intubation Car vs. Tree – femoral #, pelvic #, difficult intubation

Charleville Hospital Emergency Simulation & Training (CHEST) Course Nursing Feedback – Relevant, useful, challenging ‘Nice atmosphere in the room’ Good opportunity to talk through difficult cases with medical staff Caused them to reflect on recent resuscitation patients Increased confidence using defibrillator Increased familiarity with telehealth technology Increased familiarity with advanced interventions i.e. intubation Simulation practise was recalled in later situations

Criteria for Effective Simulation Education In response to a needs analysis Review of recent critical cases Staff reports of knowledge / practice gaps Patient presentation statistics Fidelity Patient, equipment, situational Repetition, revision, consistency Clear Expectations Learning Behaviour Performance Up to date evidence-base (Issenber, et al., 2012; Norma, et al., 2005) (Salas, et al., 2008; Lazarra, et al., 2014)

Lessons Learned Leadership buy-in Address issues outside the algorithm Education engagement is downstream of ward culture Patience, and consistency Beware unintended consequences – technology breeds complacency “The doctor would be here by now..” Build in evaluation process from the beginning Enthusiasm is infectious

Thank you very much for your attention Samuel Brookfield R.N. samueljbrookfield@gmail.com 0437 934 764

References Lazzara, E. H., Benishek, L. E., Dietz, A. S., Salas, E., & Adriansen, D. J. (2014). Eight critical factors in creating and implementing a successful simulation program. The Joint Commission Journal on Quality and Patient Safety, 40(1), 21-29. Norman, G., Dore, K., & Grierson, L. (2012). The minimal relationship between simulation fidelity and transfer of learning. Medical Education, 46(7), 636-647 Issenber, B. S., McGaghie, W. C., Petrusa, E. R., Gordon, L. D., & Scalese, R. J. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical Teacher, 27(1), 10-28. Salas, E., Wilson, K. A., Lazzara, E. H., King, H. B., Augenstein, J. S., Robinson, D. W., & Birnbach, D. J. (2008). Simulation-based training for patient safety: 10 principles that matter. Journal of Patient Safety, 4(1), 3-8.