The variety of models of initial training present nursing managers with challenges in the recruitment and deployment of personnel trained in many different jurisdictions. Nursing managers need to consider the potential for considerable variation in competency repertoires among nurses trained in generic and specialist initial training models.
monitored. Participants' confidence was monitored with questionnaires. Observer checklists were analysed in crossdepartmental meetings looking for solutions. QI aims were categorised into efficiency, patient safety and reducing wastage. Results A total of 9 SPRinT courses and 8 PDSA cycles were completed between 2012 and 2018, with 74 participants. Feedback forms suggest realism of the scenario's environment and stress level were 82% (IQR 70-90%) and 80% (IQR 65-90%) respectively. Latent threats were identified resulting in 7 significant QI projects (figure 1). Time for emergency blood administration improved from 6.15 mins to 2.0 mins (reduction of 2/3rds). Discussion/Conclusion Over 3 years of simulation-based PDSA we have overhauled our Major Blood Loss Protocol (figure 1), resulting in increased participant confidence and reduced time to initial blood transfusion. QI projects have included tackling systems issues such as a lack of overnight access to an outlying site, providing improved resources eg a cordless phone for Bloodbank. The iterative simulation process was used to improve our Major Blood Loss Protocol by combating latent threats, and for staff training. The time to resolve major QI issues was greatest for estates issues (4 years) followed by additional resources (1 year) and training (6 months) (table1). We have shown that with targeted in-situ simulations, and determination, major improvements are possible in cross departmental protocols.
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