1. Dr Rob Greenhalgh (KSS Emergency Medicine Register)
Dr James Hargreaves (BSUH Emergency Medicine Simulation Fellow)

2. Session Plan What are Prompt Cards – and Why?! Video Live Simulation
Debrief the Simulation
Discussion about introducing Prompt Cards

3. Why is the Emergency Department unique?

4. Emergency Prompt Card Project
Aim: To empower all ED staff to use Prompt Cards to promote Patient Safety
In 2014 all stakeholders engaged in the development and implementation of the Prompt Cards
ITU
Anaesthetics
ODPs
ED Consultants
ED Nurses
Outreach Nurses
SEC Amb

5. Contents Clinical Scores Trauma, Transfers, Briefings
1) Trauma/ASHICE Briefing
1a) Trauma Imaging/Interventional radiology
2) Pre-Transfer Checks
2a) Arrival Checks
3) Initial Management of Severe Burns
3a) Burns Chart and Considerations
4) Thoracotomy in Trauma
Medical Emergencies
5) Sepsis
5a) Not responding to initial management
6) Hyperkalaemia
7) Massive Pulmonary Embolism
8) Diabetic Ketoacidosis (DKA)
9) Life threatening Asthma
10) Unexplained Hypotension
11) Prolonged Seizures/Status Epilepticus
12) Adrenal Insufficiency
13) Malignant Hypertension
14) Severe Pre-eclampsia
14a) Eclamptic Seizures
15) Emergency Laparotomy Assessment
15a) Emergency Laparotomy Plan
Anaesthetics and Resuscitation Guidance
16) Adult ALS
17) Paediatric ALS
18) Newborn Life Support
19) Emergency Cardioversion
19a) Adult Tachycardia Algorithm
20) External Pacing
20a) Adult Bradycardia Algorithm
21) Anaphylaxis
21a) Anaphylaxis Algorithm
22) Traumatic Cardiac Arrest Algorithm
23) Post Resuscitation Care Algorithm
24) Rapid Sequence Intubation (RSI) Checklist
24a) Emergency RSI Checklist
24b) Difficult Airway Society (DAS) Guidance
25) Sedation Checklist
26) DAS Can’t Intubate/Can’t Oxygenate Guidance
27) Code Red Haemorrhage
Procedures
28) Central Venous Catheter Insertion
29) BTS NIV Guidance
30) BTS Pneumothorax Guidance
31) Organ Donation
Medications
32) Naloxone Infusion
33) Aminophylline Infusion
34) Salbutamol Infusion
35) Starting Vasoactive medication
36) Labetalol Infusion
Clinical Scores

6. Changing the Culture (2014)
I do not want Prompt Cards. Are you really getting on this bullshit checklist bandwagon? – Anaesthetic SpR
I don’t use the sedation Prompt Card because I don’t need it. We are experienced and can cover everything on the card.
– ED Consultant
I’ve never seen any bad practice so why do we need these cards
– Anaesthetic SHO
The RSI checks aren’t needed – ITU Consultant
I’ve never had a problem yet so I don’t see why I need to use the RSI prompts - Anaesthetic Consultant

7. Video

8. Password is Prompt

9. Simulation

10. Simulation Scenario
S In A&E Resus, Joe Brown, 24 y/o male, requiring sedation B Fall approx 5ft onto right ankle whilst skateboarding. No other injury. Normally fit and well, no regular meds. A Right ankle bi-malleaolar fracture dislocation with altered distal sensation and weak pulse. R Requires prompt reduction under procedural sedation. Sedation checklist to be used.

11. Who wants to have a go at using a Prompt Card?

12. Updated 30/04/2015
RECORD ANY RSI OR SEDATION IN THE EMERGENCY BAMBOO.BSUH.NHS.UK
IMPLEMENTED OCT VERSION REVIEW DUE OCT Document NOW! Prompt Card 25

13. Simulation Debrief (Technical and Non-technical Skills)

14. Simulation Debrief Technical How to use prompt cards Ease of use
Non-Technical/Human factors 
Situational awareness
Reducing ‘swiss cheese’ effect
Communication
Equipment checking

15. Introducing Prompt Cards… What barriers might need to be tackled?

16. Prompt Cards in Action
“I used the prompt card challenge a doctor to stop the incorrect rate and dosage of a naloxone infusion”
ED Sister/Charge Nurse
“The intubation Prompt Card creates a minute to communicate with the team and check everyone is clear on the plan. It helps me signify we are about to begin and I find that helpful.”
Anaesthetic SHO
“I was able to rapidly look up the procedure for a drug infusion that is not often used.”
By me showing the prompt card the doctor went through the sedation checks and we identified equipment was missing before we started.
ED Staff Nurse