Utilising in situ simulation within translational simulation programmes to evaluate and improve multidisciplinary response to anaphylaxis in the paediatric emergency department

Abstract

Objective: The prevalence of paediatric anaphylaxis is rising in Australia. Treatment requires timely administration of intramuscular (IM) adrenaline. Study goals included utilising in situ simulation (ISS) within a translational simulation (TS) programme as a diagnostic tool to identify the frequency and cause of IM adrenaline errors in a paediatric ED, and utilising ISS to evaluate multidisciplinary emergency team response to anaphylaxis. Methods: A prospective observational study was conducted in the Royal Children's Hospital Melbourne ED utilising an ISS anaphylaxis scenario with a debrief pro forma within an established ISS/TS programme. Results: Twenty-three anaphylaxis ISS were delivered over 16 months. One hundred and sixty-four multidisciplinary staff participated (mean of 8 per session). Median times (in minutes) for the total ISS were 12:33 (interquartile range [IQR] 9:06-15:19), consisting of the scenario 4:07 (IQR 3:33-4:44) and debriefing 9:00 (IQR 5-11). IM adrenaline was administered in all ISS within 5 min, median 2:57 (IQR 2:30-3:40). Adrenaline medication errors occurred in 30% ISS (7/23).Errors included three (13%) administrations and four (17%) potential or 'near misses' associated with a verbal order or medication preparation error. A weight-based medication cognitive aid was utilised in 56% (13/23) ISS but was not utilised in all three administration errors. Conclusions: ISS within TS programmes was successfully utilised as a diagnostic tool in identifying that medication errors were common during anaphylaxis management in the ED. Improving access to adrenaline in dosing boxes and promoting the utilisation of weight-based cognitive aids alongside ISS education will likely reduce errors and improve patient safety.

Management of Refractory Anaphylaxis: An Overview of Current Guidelines

“…Given that RA is not a rare occurrence in either the community or hospital setting and the underuse of adrenaline in anaphylaxis, healthcare professionals and prehospital providers must be familiar with the correct recognition of anaphylaxis, understand the steps which are essential to the adequate management of RA [2]. For example, staff working in Emergency Departments and Allergy Challenge settings should undergo simulation training which includes the management of RA—something which has been done for staff in the perioperative setting for many years but also in a paediatric emergency department and an allergy clinic [75–77]. High‐fidelity simulation training has been shown to improve performance during resuscitation [78], and it is likely that this applies to specific simulation training on RA, although data are limited as to whether this translates into improved outcomes.…”

“…RA [2]. For example, staff working in Emergency Departments and Allergy Challenge settings should undergo simulation training which includes the management of RA-something which has been done for staff in the perioperative setting for many years but also in a paediatric emergency department and an allergy clinic [75][76][77]. High-fidelity simulation training has been shown to improve performance during resuscitation [78], and it is likely that this applies to specific simulation training on RA, although data are limited as to whether this translates into improved outcomes.…”

Translational simulation revisited: an evolving conceptual model for the contribution of simulation to healthcare quality and safety

“…The efficiency, safety and effectiveness of patient care journeys have provided fertile ground for healthcare improvement using translational simulation. Examples include: introducing ward-level high-flow oxygen care for infants with bronchiolitis [ 39 ], optimization of paediatric airway emergency carts to improve response times in emergencies [ 56 ], improved time to intervention in acute stroke [ 57 ], improved multidisciplinary response to anaphylaxis in the paediatric emergency department [ 58 ], improving rapid transfer to the operating theatre for critically unwell trauma patients at a tertiary referral hospital [ 59 ] and reducing the ‘door to needle’ time for patients suffering a myocardial infarction who required safe and fast transfer from the emergency department to cardiac catheter suite [ 60 ].…”