EMS had been utilizing simulation since its inception. Our educators have a long history of creating activities with enhanced realism and immersion for EMS participants. Most of us can recall instructors role playing a scenario early in the education experience to gain practice completing an accurate patient assessment.
EMS for decades has been demonstrating competence for CPR skills on manikins that provide feedback about accuracy. The use of simulation has long been utilized in other industries to improve accuracy and safety. The aviation, military, nuclear medicine and shipping industries all have success in improving safety and reducing human error using simulation. It has surely grown into a mainstay EMS practice for assessment of competency, exposing participants to low frequency, high risk patient cases and overall provider quality improvement. Despite the adoption of simulation, there are opportunities to improve the execution of simulation experiences that have the potential to drive culture change in a department and larger organization.
Developing a high reliability department requires purposeful leadership. In healthcare, error has negative impacts on patients, families, clinicians and organizations. Establishing a simulation program that is fundamentally safe, both physically and psychologically, for participants to discover flaw in practice, near miss events and even error, drives patient outcome improvements.
This philosophy may be uncomfortable for EMS leadership and personnel. Fundamentally, being “wrong” or causing “error” is tied to vulnerability. It is imperative that EMS educators help reframe the stigma of vulnerability for purposes of embracing the very strength that can emerge from a vulnerable experience. Dr. Brene Brown reveres vulnerability as the birthplace of creativity, innovation and change. These are fundamental skills for high functioning EMS providers who are constantly challenged to adapt in an uncontrolled and unsupervised patient care environment.
The cost of a lawsuit, fiscal impact of a customer complaint or low employee morale are well studied and understood to have negative impacts on organizations. Effective delivery of simulation activities has a cost associated. When delivered soundly, the cost-benefit ratio can serve as protection for the organization. The experiences drive culture improvement and can change practice to achieve higher reliability. They also can help clinicians move from unmindful to generative thought patterns where they seek safety improvements. Here a few examples.
1. Medication administration safe practices
The evidence is clear that medication administration is a high-risk clinical skill. Human factors play a significant role and can often lead to catastrophic outcomes. Promoting medication cross checks during the procedure has shown to improve patient safety. In an EMS environment, these cross checks are often not utilized nor embraced as part of practice. The rushed culture promoted by EMS history compounds the belief that a cross check requires significant time which could negative impact outcomes. The truth is that an accurate medication cross check requires 30-45 seconds. Using simulation to practice this important safety step is essential to shifting culture belief within a department. Once providers practice the protocol, designing a scenario with a latent error can help reinforce the power of mindfulness in clinician practice, which will yield to better safety outcomes.
2. New equipment selection
EMS technology is rapidly changing and advancing. Equipment selection can impact quality of patient care delivery, staff morale and budget improvements. A useful strategy is to establish an equipment task force comprised of department members. Obtain samples of different equipment models and conduct standard patient simulations to trial and assess the equipment functionality within a simulation case. Often, equipment modifications are driven from near-sentinel or sentinel events. These cases can be utilized as the premise of the simulation case, but remove HIPAA specific information. Important formal team feedback may be obtained when using this process.
3. Leadership training
Often, the best clinicians are chosen to move into EMS leadership without appropriate training. Leadership skills for supervisor or manager success are not the same skills as leading during a live patient care situation. While some similarities exist, a supervisor must lead to a high purpose for greater reliability. Standardization in responses and interactions with staff are important for improving stability within the department. Developing leadership simulation activities focused on opportunities to practice improved staff communication, de-escalation techniques, enhanced problem-solving tactics and effective feedback, creates standards to achieve more effective teamwork, better outcomes and improved quality results. Utilizing simulation allows the leadership team to develop synergy and embrace best practices.
Simulation activities are vital to EMS. Simulation is a proven modality to educate, assess and enhance consistency. Simulation activities focused on assigned objectives, that are delivered in a psychologically and physically safe manner, which include self-reflection and a facilitated debriefing, are proven to improve provider decision making. Utilizing these same strategies for EMS service improvement will surely improve patient outcomes and increased reliability. Higher reliability brings less risk, improved safety and is part of our roadmap to better patient care experiences.
CPS ‘ROAD TO RELIABILITY’ WEBINAR SERIES
As part of its year-long Road to High Reliability learning series, the Center for Patient Safety is offering a webinar, “Learning with Simulation,” on Mar. 17, 2021, at 1 p.m. CST. Jennifer McCarthy, MAS, NRP, CHSE-A, will describe how simulation can be used by leaders to optimize day-to-day operations while hard-wiring safety culture. Learn how simulation can be used to teach and reinforce a safety culture while improving clinical skills. You will learn new ways to enhance the effectiveness of simulation beyond traditional thinking and reduce preventable patient harm within your organization.
Visit the CPS’s “The Road to High Reliability” for additional information and to register
Plan now for national Patient Safety Awareness Week, March 14-20. Highlight and celebrate your organization’s ongoing efforts to provide safe patient care by downloading a free toolkit from the Center for Patient Safety. The Toolkit contains posters, social media graphics and tips to make the week a success at your organization. Together, we are better, stronger and safer!
About the speaker
Jennifer McCarthy, MAS, NRP, CHSE-A, serves as the director of simulation and clinical associate professor for the School of Health and Medical Sciences, Seton Hall University, where she designs and delivers simulation activities for six graduate healthcare programs. Jennifer is also the president and founding member of 579 Solutions, LLC. 579 Solutions is a consulting company dedicated to enhancing innovation and positive change to patient care focused organizations. Jennifer holds many positions with the Society for Simulation in Healthcare. She is the vice chair of the Credential Commission, a voting member of the Meeting Oversight Commission (MOC) and an accreditation site reviewer and team lead. Jennifer has earned the distinguished credential of Certified Healthcare Simulation Educator – Advanced (CHSE-A) which is bestowed on less than 100 simulationists globally. Jennifer was named one of the Top 17 People to Watch in Healthcare (201 Magazine, January 2015) and has received the EMS Career Lifetime Achievement Award (November 2015).
