2008
PRIMED and ready to go.
Molyneux R1, Harrison T2, Harrison L3, & Roberts R2
York District Hospital, Bradford Royal Infirmary, Royal Derby Hospital
PROBLEM: Haemodialysis offers some unique challenges to the multi-disciplinary team, especially when managing acute emergencies. Many dialysis units across England face the same concerns and problems. We identified a need to strengthen the training of the haemodialysis multi-disciplinary team (MDT) especially in a unit like ours which is not situated on acute hospital site. We recognised that simulation could be a suitable tool and were aware that in-situ simulation has been used to improve management of acutely ill patients on dialysis. We wanted to see if this could be transferred to our dialysis unit with similar benefits.
PURPOSE: The aim was to provide a practical interdisciplinary training for doctors, nurses, and dialysis technicians which could be used in another dialysis unit. The simulation session would aim to improve the confidence of staff in the management of acutely unwell patients during haemodialysis.
METHOD: Practical In-situ Medical Emergencies on Dialysis (PRIMED) has been running for 2 years, showing an increase in confidence of the multi-disciplinary team in dealing with emergencies on dialysis. In our region we have considerable experience with simulation programmes. A template was constructed which would allow the simulation scenarios to be run in another centre.
Sessions took place on the haemodialysis unit twice a month, using a high fidelity mannequin, in conjunction with a dummy haemodialysis treatment.
Each session involved 4 dialysis unit staff and 2-3 doctors. The effects of the training on staff confidence and abilities were evaluated. Staff subjectively assessed their confidence before and immediately after the session, by rating their agreement with 11 Likert questionnaire items. These included aspects related to ability and confidence in managing the dialysis treatment itself, delivering basic life support, assisting the arrest team and providing a relevant SBAR handover.
RESULTS: The mean confidence scores of the staff in managing emergency situations improved in all of the simulations. A t-test was performed which demonstrated significant improvement in confidence in managing a cardiac arrest on the haemodialysis unit (p < 0.0005) and also in using an accurate SBAR handover (P< 0.0005). Confidence sores were also increased in all other aspects, but did not show significance.
CONCLUSION: The implementation of in-situ haemodialysis training has already been proven to improve confidence levels. We have shown that this can be duplicated with similar results in another dialysis unit, using the same techniques and similar scenarios.
RELEVENCE: Multi-disciplinary training is crucial to provide safe, effective treatment during acute haemodialysis emergencies. Simulation has been shown to be an effective educational tool for MDT training. An in-situ dialysis course which can be transferred to other dialysis units will enable other teams to improve in their ability to work together in a team and be effective dealing with emergencies.