January 28, 2019By Lance Baily

IMSH 2019 Day 2 Megathread – All the Latest Updates

Past President Christine Park, MD opened IMSH 2019 with the Society of Simulation in Healthcare‘s new Code of Ethics, which are self-imposed and aspirational values that demonstrate peer to peer relationships and responsibility. Based on the UN Code of Ethics which include integrity, transparency, mutually respectful professionalism, accountability and results of orientation, nineteen simulation affiliated organizations have already agreed to incorporate the ethics code. Our staff updated this article throughout the day with all the latest recaps! For those new to the website, welcome to HealthySimulation.com, the world’s leading resource website for all things Healthcare Simulation. Before anything else, take a quick moment to sign up for our free bimonthly medical simulation email newsletter so that you can keep up to date with all the latest healthcare simulation news, job listings, resources, product demos and more! Read the IMSH 2019 Day 1 Recap Here.

Lou Oberndorf Lecture on Innovation in Healthcare Simulation: Sir Ken Robinson

Lou Oberndorf took to the stage to introduce his lecture series on innovation in medical simulation, introducing Sir Ken Robinson. As an internationally recognized authority in creativity and innovation in education and business, Sir Ken Robinson is also one of the world’s leading speakers. Videos of his famous talks to the prestigious TED Conference are the most viewed in the history of the organization and have been seen by an estimated 300 million people in over 150 countries.

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Sir Ken works with governments in Europe, Asia and the US, international agencies, Fortune 500 companies and leading cultural organizations. He led a national commission on creativity, education and the economy for the UK Government, was the central figure in developing a strategy for creative and economic development as part of the Peace Process in Northern Ireland, and was one of four international advisors to the Singapore Government for a strategy to become the creative hub of SE Asia.

Called “one of the world’s elite thinkers on creativity and innovation” by Fast Company magazine, Sir Ken has received numerous awards and recognitions for his groundbreaking contributions. His latest book, Creative Schools: The Grassroots Revolution That’s Transforming Education, written with Robinson’s trademark wit and engaging style, includes groundbreaking research and tackles the critical issue of how to transform the nation’s troubled educational system.

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Sir Ken Robinson started his presentation considering how every child learns to speak within a few years without the instruction to do so — highlighting that human beings have a an extraordinary capacity, and children love to learn. While children love to learn, education is interrupting that joy with systems cloaked in a toxic culture of testing based on data, a loss of ability to “play”, and a false promise of going to school and doing well leads to guaranteed jobs.

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While attendees most likely played for hours in their youth, children today are kept in doors, losing recess to more study time, and not allowed to be outside more than 15 minutes a day. Children’s play is the prototype of simulation, mixing physicality and imagination for the first time — to rehearse in a safe environment is a fundamental trait of human intelligence. Robinson continues to focus on building coalitions dedicated to support children’s play, a simulation for adult understanding. Every age thinks they are the end of technology development, and every age has been wrong! He reminded us that systems create problems, but we as educators can change the options available to learners, giving them the ability to grow. He concluded that many of our technologies have alienated us from our environments, especially in school systems, and the essential relationship of recognizing people’s spirits for creativity must be recognized and cherished.

Poster & Session Updates From Day 2

Shifting the Culture of Safety Through SimulationPoster Presentation presented by Kailey Green, MSN and Hannah Watts, MD from Advocate Health Care, Illinois. In 2016, Advocate Health Care identified three serious safety events  (SSEs) connected with late or missed recognition of retroperitoneal hemorrhage (RPH). Through root cause analysis, power distance relationships and communication were identified as contributing factors.

  • Simulations were created to eliminate SSEs related to RPH and to improve safety by using existing “Be Safe” tools.
  • Inter-professional simulations were created which included early identification of RPH and power distance challenges.
  • Two different scenarios were created.
  • Debriefing focused on early recognition of RPH and communication skills (“Be Safe” tools).
  • 84 sessions were conducted with a 98% participation rate.
  • ZERO serious safety events related to RPH have occured since inception of the training.
  • Clinical openness percentile rose from 22 to 56% for nurses and 74 to 89% overall.
  • The investigators concluded that simulation can be designed to target specific problems identified by root cause analysis and interprofessional communication and speaking up for patients can be incorporated in simulations.

This study clearly showcased the power of simulation to improve patient safety!

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Create, Redesign or Redefine Your Ideal In-Situ Program.  North Carolina Simulation Centers and Collaborative.

Participants worked in groups to share ideas about in-situ programs.  Some of the key ideas:

  • Include all stakeholders in the planning phase.  When planning interdisciplinary sim don’t forget to include all possible participants such as pharmacy, respiratory tech, radiology, code announcements broadcast to whole hospital etc.
  • Goals may based on a root cause analysis of errors/near misses or process flow of sim.
    • must show consideration for the safety of learners and patients.
  • Always trial new simulations.   Identify logistics for example:
    • Transport of equipment (no manikins hidden under sheets!)
    • Supplies and equipment
    • Real meds and equipment versus fake.  
      • Consider using checklists.
    • Participants, level of learners
  • Be prepared to cancel sim for example pediatric code when child has just died on the unit or low staffing ratios.
  • Always evaluate
    • Take data back to stakeholders.
    • Use data as resource to develop funding
    • Latent safety issues may be revealed
    • Take photos of involved learners (a picture worth a thousand words)

Subcommittee Meetings

Many subcommittees met for group meetings.  Examples include:

  • Patient Safety & Simulation Collaborative Affinity Group – included information about webinars and posters presented by the group.  Sharing of ideas between a diverse membership of primarily hospital based sim groups that focus on developing simulation related to patient safety issues.  Often related to critical events or patient safety issues.
  • Subcommittee Committee
    • Reports from various committees related to activities including:
      • The SSH Simulation Academy Committee which is free to join.
      • The SimBook committee which is developing an ebook with free scenarios. Each simulation is tested at least twice. This group is looking for authors and reviewers and welcomes new members.

Clinical Event Debriefing – Lessons Learned From Unique Initiatives Across Multi Institutions, Amish Aghera – Moderator

This panel discussed recommendations, experiences and possible problems related to debriefing clinical events.

  • Clinical Event Debriefing is different to debriefing that occurs in a simulation lab with a manikin.  Focus is on communication, team interactions and systems and not on medicine per se.
  • Debriefing should be done just as much when events go well as when they do not.  Positive feedback to practitioners is valuable and promotes repeat of best practice behaviors.
  • New debriefers should start with cases that go well. This encourages the new person and gives them confidence.
  • Someone needs to be responsible for following up on recommendations from debriefing.  If nothing changes, debriefing will lose its value. On the other hand, when participants see change in response to debriefing, they will value the process.
  • Debriefing sessions should be on time and short.
  • Discoverability and liability.  Have clinical debriefing programs come under quality improvement committee because their activities tend to be protective.
  • Debriefing following death of patient is not well documented in the literature and there is controversy related to this issue.  One suggested method:
    • Offer a moment of silence
    • Inform participants that attendance is entirely optional
    • Take a few minutes to pull out what went well
    • No “what should we do next time”
    • No system review.  

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