International Journal of Healthcare Simulation

Background:

In situ simulation, in the clinical environment, can help detect any issues with the systems, policies and practices within an organization that may not work. Many system errors go unnoticed until there is a real incident. Conducting simulation in situ is an innovative way of picking up these embedded problems ^[1]. Experiential learning theory suggests that, to truly understand a concept, you must experience it first-hand by doing it. Deliberate practice ^[2] recognizes that to gain expertise you must keep practicing a skill. Practicing tasks in a simulation environment helps to build performance levels and thus improves patient care and safety.

Aims:

This simulation exercise is designed to develop the skillset of foundation dental therapists in respect of Medical Emergency recognition and management in their own working environment. The parameters for assessment included teamwork, knowledge, communication, effectiveness of actions and situational awareness.

Methods:

Research methods for this project included a learning needs analysis, surveying and interviewing previous cohorts of hygiene therapists. The conclusions of which highlighted the need for further training in managing medical emergencies. The learning needs identified from stakeholders relating to this course have been used to develop the learning outcomes using Blooms’ taxonomy ^[3]. The faculty delivered a medical emergency in situ simulation training session for Dental Foundation Therapists across the Midlands and East region. The therapist and dental nurse were given information on the ‘patient’ before the interactive mannikin was positioned. Facilitators used an adjacent room from which to control the mannikin, including its vital signs and voice. A 360-degree camera along with iPads were used to monitor and record the session for safety and debrief purposes. The therapist worked with their dental nurse to react and respond to the emergency unfolding before them. They then watched back their performance, reflected and provided feedback.

Results:

Using GIBBs model of reflection, the 2021 delegates recognized personal learning needs including improvement in leadership and management skills, delivery of chest compressions and teamwork. Changes to practice were also recognized, for example, placing their emergency drugs in a more appropriate location. Using video, a ‘Hot Debrief’ method of evaluation was carried out whilst the experience was fresh. This proved to be powerful and enhanced personal reflection to support future learning and development. Later, an evaluation method in the form of a survey took place. Results of which showed that 50% of delegates had never partaken in simulation-based education before and 100% gave an excellent rating on the benefits to team and individual. One participant stated ‘this was such a good, real-life experience! I hope this can either be introduced into undergraduate training or as part of the practice annual BLS CPD!!’.

Implications for practice:

A successful session needed prior communications with the practice staff to free up a surgery for use, inform present patients of the activity and understand where the emergency equipment was during the session for patient safety. The benefits of conducting in situ simulation were staggering, the delegates reviewed their current practices and made changes as appropriate.