Oral Themed Presentation
Context: : Infection is one of the top most causes of death among all age groups in India. Pediatric Simulation Training and Research Society (PediSTARS) India identified significant gaps in management of septic shock and team work during simulation workshops. There were lack of common protocol in management of septic shock in many hospitals . We also discovered that many senior faculties trained by PediSTARS find it challenging to commence in situ simulation at their workplaces.
To address these challenges, PediSTARS called for a nationwide in situ simulation during “Global Simulation Week – 2018” organised by Society for Simulation in Healthcare (SSH). The theme was “Septic Shock Management - Make it Happen at Bedside” We share our experience in partnering with PediSTARS members, preparing the teams and planning system changes after the simulation week by 57 centers in India and 4 other countries to care for septic shock patients and to commence regular in situ simulations
Description: : Faculties trained in simulation by faculty development workshops since past 4 years were approached. Preparation for the event was made for several weeks through WhatsApp (WA) group by 1) Generating discussion on simulation week, burden of sepsis on country, 2) Personal request to seniormost physicians to pledge for sepsis simulation on WA group to inspire others 3) Sharing 4 scenarios on septic shock (neonate, pediatric, adult and anesthesia /surgeons) 4) Current guidelines septic shock ( American college of critical care medicine) and algorithm was shared. 5) Motivational daily messages on WA group regarding creating high fidelity from low cost manikins, psychological safety, modify scenarios to local needs, debriefing varied learners generated interesting discussions 6) Photographs sharing from previous septic shock scenarios including moulages and push pull technique - stimulated many to come up with innovative ideas on WA group
PediSTARS members conducted simulation in from 17-21st September 2018. They posted daily photographs and experiences on WA group. Formal feedback was collected online from each hospital.
Observation/Evaluation: : 130 Facilitators (11 nurses) from 57 centers in 5 countries - India 53, SriLanka 1, Abudhabi 1, Spain 1, London1 conducted 134 scenarios for 407 doctors, 494 nurses and others. Areas conducted: PICU 50, sim lab 18, auditorium 16, emergency department 14, adult ICU 11, pediatric ward 11, NICU 10, labor room 2, operation room1, clinic 1. Major gaps identified in assessment, management, communication. 54 centers made system cahnges ( average4). 3 centers reported no system changes. Most common changes made in the systems were- algorithm display (27 centers), plan regular team training by in situ simulation (23), push pull technique (20), early antibiotic policy (18), SBAR handover (16). Preparedness-bed space and equipment checklist (13). Other system changes were –commence code blue system, implement PEWS score and rapid response team, train all hospital staff in sepsis management, display emergency contact numbers, rotation of ward residents to intensive care, intubation bundle, hand hygiene protocol, IO drill, debrief real crisis scenarios.
Discussion: : Sepsis management is the much-needed challenge and in situ simulation is a powerful tool to make system changes to improve patient care. Themed approach at regular intervals to address similar problems by conducting mass scale in situ low cost simulations might be a ray of hope not only for low resource diverse country like India, but also for other countries.