Oral Themed Presentation
Context: : The neonatal intensive care unit at Liverpool Women’s Hospital has over 1000 admissions per year, providing an extensive range of specialist services for neonates. In December 2017, the service secured £15 million funding to upgrade its existing unit, to address issues of cot number and parent accommodation shortages, and comply with national service specifications. This large scale project has required significant cross-profession working, not only to ensure that the new clinical areas were purposeful, but also that staff and families were sufficiently orientated to the new unit, with meticulous embedding and checking of all safety equipment, systems and new clinical processes, prior to any infant being cared for in these areas. The use of simulation has been key to this process and this work will be significant to anyone involved in unit redesign and / or safety proofing existing clinical areas.
Description: : Phase 1a of the new building plans has now been completed (November 2018), which involved transferring twenty low dependency cots upstairs into a refurbished clinical area, separated from the rest of the neonatal unit, and the introduction of a further six parent rooms. This phase was crucial for the expansion of the unit to start, though by moving these infants, attention to emergency processes, for example, summoning the resuscitation team, was of utmost importance and all staff needed to receive adequate training on these. Close working relations with the contractors were paramount during this process, not only to ensure that there was adequate time in order to undertake staff orientation visits, and test emergency procedures, but also that any issues regarding the design could be addressed prior to the unit going live, working within the strict development time constraints.
Working from an adaptation of the author’s model for the implementation of in-situ simulation (1) , seven neonatal simulation enthusiasts worked closely with unit managers, the contractors, fire safety officers and other relevant hospital departments, in order to create and implement a programme of staff orientation and a range of simulations, of varying complexities, to test all of the safety call systems and orientate over 200 clinical staff in the short one-week period where the new unit was safely accessible to staff, though contractors and managers were around to address and correct issues.
Observation/Evaluation: : The sessions, led by at least two members of the simulation team, orientated over 200 members of staff to the new clinical area, providing logistical safety information and embedded a change in practice in summoning the neonatal emergency team, tested in real time during such sessions using in-situ simulations. Issues relating to the emergency call bell systems in different areas of the unit were highlighted during such sessions and rectified immediately. All staff found the sessions to be invaubale and felt more confident in summoning the emergency team, using the switchboard operator and also obtaining emergency blood and extra assistance in a timely manner. Staff also rated the importance and usefulness of the integrated simulation highly in understanding how the new unit would function.
Discussion: : The integrated simulation into the sessions greatly increased staff confidence with the new unit and system changes. The close involvement of the constructors was hugely important during this work and has aided their buy-in for similar work to be continued throughout the rest of the project over the next two years.