Simulation Training in Oxford (AICU and CICU)
Simulation-based training has become fully integrated into the life of the multi-professional team on ICU with an exponential increase in staff enthusiasm. Opportunities are numerous and varied, planned and impromptu, reflecting the flexible nature of simulation as an educational tool.
In-Situ simulation training, which takes place in a bed space on ICU, has become routine, is driven by local Clinical Governance priorities and is always multi-disciplinary. With our own high-fidelity mannequin and a pro-active education team, this training is delivered on both AICU and CICU according to clinical pressure. In-situ training enables staff to participate during their usual working hours and in their working environment, enhancing their familiarity with the location and use of equipment and drugs and importantly, training within the teams in which they work. Incorporating real local clinical incidents encourages engagement, reflection and learning. New procedures and protocols are integrated, increasing staff awareness and testing the usability of the tools. Latent safety threats can be identified, further contributing to ICU patient safety.
Examples of in–situ simulation activity include:
1. 3-monthly ‘Induction’ simulation. - All newly rotating ICU doctors, from Foundation years to Post CCT fellows, are teamed up with on-shift nurses to manage a simulated airway emergency. The tracheostomy emergency algorithm and local intubation procedure and checklist are all embedded and a full debrief crystallises learning objectives.
2. Difficult airway management for ICU nurse Team Days – In response to a SIRI and as part of a morning focused on Crisis Resource Management, the nurses participate in a ‘Cant Intubate Cant Oxygenate’ scenario, with on-shift doctors and physiotherapists, progressing to Front of Neck Access.
3. Acute Structured Assement (ASA) course – a mobile simulation course, challenges a team of doctors and nurses in the assessment and management of a critically ill medical patient from the front door of the ED through radiology and into ICU.
4. Impromptu simulation scenarios take place at the discretion of the duty consultant and nurse in charge, when bed space is available. These efficient training episodes have tested skills such as Basic Airway Management, Pacing and Defibrillation which were identified as learning needs when staff were surveyed.
We are extremely fortunate to have the support of the OXSTAR centre, a bespoke simulation facility with an expert team of technicians and trainers, which has hosted a well-established program of multi-disciplinary training for ICU staff. Training in OXSTAR allows more complex scenarios to be recreated during allocated time, away from the pressures of the clinical area.
Examples of OXSTAR training for ICU staff include:
1. 3-6 monthly ICU OXSTAR MDT training – Now running for 4-5 years, these highly rated half-day sessions, with a multi-disciplinary ICU faculty, bring together small groups of nurses and doctors from all stages of training, with a particular focus on enhancing the teamwork and communication skills in a crisis.
2. SASI project – A research project, focused on improving Situation Awareness training for ICU staff (a cognitive skill which is vital to the successful management of rapidly evolving clinical scenarios) provided 19 teams of ICU doctors and nurses with 2.5 hours of 1 on 1 training from the director of the OXSTAR simulation centre.
3. 2 monthly Transfer Training courses – A well-established lecture, skills and simulation based all-day course run by ICU staff and supported by OXSTAR, providing simulation training to doctors and nurses from Cardiac, Neuro and Adult ICU areas.
4. Regional ICM teaching for junior and senior ICM trainees in the Oxford region.
The wealth of simulation training opportunities on offer, which vary in focus, faculty and content are all underpinned by a consistent message with regarding the non-technical skills that are integral to effective team performance, patient safety and clinical outcomes in ICU. In addition, there is a positive influence on staff wellbeing as simulation represents a practical demonstration of engagement with staff, increasing their sense of belonging, encouraging team cohesion and a culture of openness and learning. There are limitless opportunities in the future for the development of simulation education and research on ICU which all staff are encouraged to get involved in!