Traditional Poster Round
Context: : Hypovolaemia is a common aetiology of perioperative cardiac arrest and has been described in children undergoing procedures involving posterior spinal fusion or craniotomies due to haemorrhage (1). This may require prone positioning of the patient and/or securing the patient’s head in a surgical clamp. Delivery of effective cardiopulmonary resuscitation has been described whilst the patient remains prone, (2) but if ineffective will require the theatre team to turn the patient. Manoeuvres such as this require effective teamwork and practice.(2) High fidelity in-situ simulation can be used to aid human factors training in the operating room.(3)
Description: : Our group devised a local management protocol for the repositioning and delivery of advanced life support, for paediatric patients in cardiac arrest whilst lying prone for a neurosurgical procedure. This was in accordance with new guidelines published by the UK Resus Council for adult neurosurgical patients.(4) High fidelity simulation was then performed in-situ using Laerdal SimJunior placed in a Mayfield clamp. This simulation allowed for latent failure testing of the protocol and improved interprofessional teamwork and communication. Peer observers were used to provide feedback commenting on clinical decision making and human factors.
Observation/Evaluation: : Likert scales were used to assess staff’s reflection on the scenario and also how applicable the use of in-situ high fidelity simulation was as an educational tool. We also requested free text reflections about the scenario in general.
Prior to the scenario of the 24 nurses and 2 doctors involved, only 2 nurses had ever been involved in managing a patient in cardiac arrest when lying prone. 6 nursing staff were candidates; 4 described themselves as apprehensive and 3 as nervous, prior to the scenario.
Following the simulation; 14/26 strongly agreed and 8/26 agreed that they felt more confident in management of a cardiac arrest during prone neurosurgery. All staff felt this was a useful topic and they would recommend the use of in-situ simulation to colleagues. Of the 6 candidate nurses, 4 described themselves as confident and 2 as positive following the scenario and gave the following quotes;
“The debrief and group feedback was valuable to my learning as it pointed out behaviours we could not see ourselves…”
“This made me think about my role in the team”
“I feel more equipped with knowledge to deal with this situation in the future”
During the simulation our team recognised 2 latent failures to be addressed; the need for standardised communication during the patient logroll and how to move the neurosurgical microscope to ensure staff safety. (Figure 1 & 2 )
Discussion: : The use of in-situ high fidelity simulation as an educational tool has been effective in our department as nursing staff feel it added to their knowledge and comfort in managing such a case. It allowed for the identification of latent failures in our local protocol which will initiate a change to the protocol. The ability to practice a complex case encouraged interprofessional teamwork and communication and this will hopefully be continued as our group identifies further scenarios for in-situ simulation.