OS2-144
Calling for Help! A High Fidelity Simulation Program for Critical Event Training in Pediatric Sedation Cases in Remote Locations
Mathew A, Kimmel M, Keliish A, Remer M, Hobbs G, Willie C, Joyner B, Blasius K
University of North Carolina at Chapel Hill, Chapel Hill, NC, United states
Introduction: Pediatric critical events are a rare but possible outcome during the administration of sedation by non-anesthesiologists for procedures in out-of-operating room (OOR) locations. In the practice of pediatric sedation, a large volume of cases occur in OOR locations and access to emergency help depends on expedient recognition and mobilization of resources by the sedation team. We developed a multi-disciplinary educational program utilizing High Fidelity Simulation (HFS) in order to improve sedation team competency and comfort in assisting with OOR critical events. We initiated our simulation program in the MRI suite. The MRI location is challenging due to the innate hazard of the magnet and the physical barrier to the patient. To our knowledge, no previous literature has been published on the use of simulation for pediatric crisis management in MRI sedation cases.
Methods: This pilot in-situ HFS program was developed by members of our anesthesia-led sedation team. Participants were divided into groups including a sedation nurse practitioner, nurses, radiology technicians and an anesthesia provider. Each group completed a simulation in the MRI scanner involving an infant with an anaphylactic reaction to contrast. A pediatric anesthesiologist and a nursing educator led a facilitated debriefing targeted at improving communication, mobilizing resources in OOR locations, initiating removal of patient out of the MRI suite, and treating anaphylaxis. A post-course survey was completed by participants for program assessment.
Results: The participants responded positively to the anonymous feedback questions at the conclusion of the course (n=10). Questions were scored on a five-point Likert Scale. Data is reported as the Mean (M):
I am comfortable with pediatric emergencies in sedations (3.8);
I can recognize the development of anaphylaxis (4.5);
The simulation was targeted to my level of training (4.6);
The simulation will lead to changes in my practice (4.3).
We also identified and implemented a streamlined approach for mobilizing emergency help from a pediatric anesthesiologist. Participant survey comments included multiple requests for simulations in other OOR areas.
Conclusion: Our pilot in-situ simulation was an effective method of educating the MRI team in pediatric sedation crisis management. Additionally, we developed a method of identifying systems issues related to delivering pediatric sedation in OOR locations within the pediatric hospital. We plan to expand our program to include additional locations and crisis scenarios. Furthermore, we have begun incorporating radiology residents into our MRI simulations and hope to incorporate more learners in other specialties in order to improve safety in various OOR locations.
References:
1. Boet S. Transfer of learning and patient outcome in simulated crisis resource management: a systematic review. Canadian Journal of Anes; 2014, Mar 25.
2. Jaimes, C. “Identification of Quality Improvement Areas in Pediatric MRI from Analysis of Patient Safety Reports.†Pediatric Radiology, 2017.
3. Willie C. Really Good Stuff: Using high-fidelity simulation for critical event training. Journal of Medical Education. 2016 October 19.
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