International Journal of Healthcare Simulation

Background:

The Royal College of Physicians Acute Medicine Taskforce ^[1] recommended the establishment of Enhanced Care areas as distinct from Critical We designed a novel purpose orientated Enhanced Care Drug trolley for our Trust’s Acute Medical Unit (AMU), where we have designated Enhanced Care beds. The Enhanced Care Drug trolley was designed to improve the time-critical management of patients experiencing hypoglycaemia, status epilepticus, hyperkalaemia, diabetic ketoacidosis (DKA) and anaphylaxis. Human factors relating to equipment can impact clinical performance in different clinical settings and minimizing this proportionally improves clinical safety.

Aim:

The aim of the study was to optimize the management of life-threatening medical conditions, requiring enhanced care, whilst minimizing the time taken for commencement of drug interventions and staff using a novel Enhanced Care drug trolley.

Method/design:

A drawer on a sealable procedure trolley was designated for each emergency and the following items were included:

Treatment algorithm

Prescription charts

Monitoring charts (where applicable)

Medications and their diluents

Sundries (needles, flushes, sanicloths etc.)

Blood forms, bottles and blood gas kits (where applicable)

Cannulation kits

Airways (where applicable)

Oxygen mask (where applicable)

A Standard Operating Procedure (SOP) was produced detailing the responsibilities of the ward manager, pharmacy team and nursing staff. Weekly and daily checklists were produced, along with a ‘seal broken’ table. The process, procedures and innovation were discussed and approved by the Drugs and Therapeutics group.

Implementation outline:

Each emergency scenario was tested in situ on the AMU using the simulation doll and trainer (see Table 1 for results). To test each drawer a corresponding scenario was created and each intervention timed. The scenario was run twice, firstly without the trolley and then again with the trolley using two sets of nursing staff. The time was recorded from when the ward team responded to the patient to when the last step of emergency drug treatment was administered.

Table 1:

Results from testing the enhanced care drug trolley

Emergency	Time taken (without trolley) (min)	Time taken (with trolley) (min)	Total time saving (min)
Anaphylaxis	16:00	07:20	08:40
Hypoglycaemia (severe)	07:40	03:45	03:55
Diabetic Ketoacidosis (DKA)	26:02	08:05	17:57
Hyperkalaemia	31:10	13:06	18:04
Status Epilepticus	18:56	13:08	05:48

Simulation testing led to modifications of the contents of the trolley after feedback from the users. To embed practice, education of the nursing staff and clinicians was commenced to ensure familiarity and confidence to use the trolley, and to ensure governance adhered to.