Traditional Poster Round

Poster

Does the use of simulation improve clinical skills and confidence of the team when managing ECMO emergency scenarios.

Tuesday, May 15
09:45 - 10:45
Location: The Gate, Atrium Level

Context: : ECMO is a high risk, low volume procedure where life threatening emergency situations are rare, however when they do occur it is vital that the ECMO specialist nurse (ESN) has the appropriate skill and education to be able to act promptly to ensure patient safety (ELSO 2010). Both ELSO (2010) and PICS (2016) recommend that low-volume centres train for ECMO emergencies every 3-6months. They advised that skills sessions may be combined with high fidelity simulation where team behaviour and cognitive skills can be assessed. Our cardiac surgical PICU has a long established ECMO service however classed as a low volume centre with <20 runs annually. The service activity (2016) at RBHT PICU was a total of 12 patients who received ECMO support of which a total of 66% survived to PICU discharge. Staffing levels at RBHT for paediatric ESN’s is currently 30. Our previous practice was to provide a one hour water drill workshop every six months. The identified need was to develop a formal ECMO update day integrating simulation for already established experienced ESN in order to meet the standards set out by ELSO and PICS.

Description: : We aimed to design, implement and evaluate a one day ECMO update programme for the ESN’s on our unit. We used adult learning theory to underpin our approach to design. We asked the ESN’s to complete the Hennessy Hicks training needs analysis questionnaire to investigate the demographics, training needs and preferred approach to improve skills and knowledge of the target population. Results from 60% of the ESN’s on the unit with a wide range of experience (1-18years), who felt emergency procedures on ECMO were of high importance and their preferred method of training for these skills were clinical simulation and practical workshops. We designed our programme using deliberate practice with water drill workshops and simulation scenarios. The practical workshops allowed the participants to practice and demonstrate emergency procedure skills: troubleshooting AIR in the circuit, motor/oxygenator failure. This was followed by two ECMO simulation scenarios integrating ECMO emergencies with debriefing that covered technical and non-technical issues. The programme was held in the simulation centre using a sim baby and an ECMO circuit. The course outcomes were measured using evaluation questionnaires.

Observation/Evaluation: : The scale of 0-100% measured a level of agreement from the ESN’s that ECMO simulation does improve their clinical skills and team work when managing an ECMO emergency situation. The results revealed a mean score of 87% which indicated a high level of agreement. A focused questionnaire measured the ESN’s self confidence level pre and post the update programme. The results showed an increase in confidence of 20-24% post the programme. These results reflect other literature which advocates that simulation-training courses may increase skills and confidence in dealing with ECMO emergencies.

Discussion: : An ECMO update programme was designed and implemented based on identified learning needs by the ESN's, utilising a combination of water drills workshops and simulation scenarios. Results found positive correlation between clinical simulation and increase confidence in emergency skills. Further studies are required to assess skill retention and clinical impact of the programme.





Rebecca Akehurst, RSCN

PICU Practice Nurse Educator
Royal Brompton and Harefield NHS Foundation Trust
London, England, United Kingdom

Rebecca Akehurst (pgDip postgraduate diploma Child Nursing) NMC member, IPSS member.
I am a PICU Practice Nurse Educator at the Royal Brompton and Harefield NHS Foundation Trust. As part of the multidisciplinary team on PICU at The Royal Brompton Hospital we have designed and implements a training update day for all of the ECMO specialist nurses’. The programme has a key focus on the use clinical simulation and practical workshops to ensure staff are confident and highly skilled in managing ECMO emergencies. The title of the poster presentation is “Clinical simulation improves confidence and clinical skills in ECMO emergency scenarios”

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Helena Sampaio, RSCN

PICU Senior Staff Nurse & Advanced Nurse Practitioner Trainee, SPRinT Faculty
Royal Brompton & Harefield NHS Foundation Trust

Presentation(s):

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Send Email for Lydia Lofton

Sandra Gala-Peralta

Consultant Paediatric Intensivist
Royal Brompton and Harefield NHS Foundation Trust

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Amy Chan-Dominy

Consultant Paediatric Intensivist
Royal Brompton and Harefield NHS Foundation Trust

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Diane Frall, RSCN

PICU Sister, ECMO Lead Nurse
Royal Brompton and Harefield NHS Foundation Trust

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Ajay Desai, MBBS, DCH, DNB (Paed), FRCPCH

Consultant Paediatric Intensivist
Royal Brompton Hospital

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Peter Weinstock, MD, PhD

Director - Simulator Program
Boston Children's Hospital, MA

PETER WEINSTOCK MD PhD
Chair and Executive Director, Boston Children's Hospital Simulator Program (SIMPeds)
Senior Assoc. Critical Care Medicine
Associate Professor of Anesthesia, Harvard Medical School


A practicing pediatric intensive care unit physician, Dr. Weinstock combines >20 years in surgery, medicine, education and innovation to lead the Boston Children's Simulator Program (SIMPeds) to one of largest most integrated "return on investment" simulator enterprises world-wide. Dr. Weinstock has weaved sustainable medical simulation ecosystems into the fabric of medical centers and regional health care systems on 6 continents and is founding president of the International Pediatric Simulation Society (IPSS). He serves on multiple advisory boards including education, simulation, social robotics and AI, and lectures internationally including "TED" on combining simulation, human factors, 3DP and special effects -- all to prepare world-class clinicians and healthcare systems to perform at their best, as well as to reduce fear and anxiety in patients and families.

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