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How we Improved Patient Care and Safety Through Simulation

Mercy Health Saint Mary’s

The following is a list of our current simulations:
• Nursing Excellence Academy: Sepsis and mock code (for experienced nurses)
• Nursing Excellence Academy: Sepsis and mock code (for nurse residents)
• Nurse Resident Simulations (unit specific): Emergent delivery, respiratory distress, heart block- using a pacemaker
• Intermediate Education Simulation: Titrating vasoactive drips
• Sedation Simulation: To validate competency with all sedation-credentialed nurses throughout the hospital (initial and ongoing)
• Rapid Response: Collaborating with the ED team on the care of critical patients
• Events: EMS-trauma, neuro, cardiac (quarterly)
• Trauma simulation once/ month
• Pediatric mock codes quarterly
• OB/NICU emergency simulations.
As our reputation grew, our services were requested to create simulation opportunities for the team to address identified gaps in practice, systems, process, and, most importantly, communication. Here is where our story begins:
One specific med-surg unit in our organization was challenged by the numbers of novice-to-experienced-nurse ratios. These ratios presented potential patient safety and communication opportunities due to lack of previous experience and confidence. The simulation team was asked to create a simulation plan to offer a safe environment for nurses to gain experience and critical thinking within an inter-professional team caring for a patient experiencing a change in condition. This also provided multiple opportunities for all team members to perfect their SBARs.
Four scenarios were developed based on patient type specific to this unit—all high-risk/high-probability situations they were likely to encounter, plus opportunities identified by the unit's leadership team. The cases included a rhabdomyolysis, a sepsis case, a pulmonary embolus, and an over-sedation.
With engagement from the leadership team, we were able to involve the hospitalist team, respiratory therapy, and the rapid response team in in situ simulations. Each RN with less than 18 months of nursing experience was required to attend two simulations. All other RNs on the unit were invited to attend as well, and many did.
Each participant was asked to complete a post-simulation evaluation. The feedback from the learners and team were very positive. Also, practice gaps were addressed in a debriefing but were also addressed in educational sessions provided later. The learners gave us comments such as: "Know your resources"; "Use resources when not sure of why"; "Utilize the skills in my nursing bucket”; and “Don’t be scared to call for help."
These in situ simulations, created to assist a novice nurse, were conducted to ensure that patients remain at the center of care at all times. The team was able to learn strategies to communicate more effectively with their patients regarding a change of condition. The patient's story often held key pieces of information that led to providing rapid and appropriate interventions.