1. 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

3. South West Hospital & Health Service Workforce Development Unit

4. South West Hospital & Health Service Workforce Development Unit

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

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

7. 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

8. 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

9. 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

10. 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)

11. 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

12. Thank you very much for your attention
Samuel Brookfield R.N.

13. 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),
Norman, G., Dore, K., & Grierson, L. (2012). The minimal relationship between simulation fidelity and transfer of learning. Medical Education, 46(7),
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),
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.