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Table 2 Summary of findings and recommendations

From: Commissioning simulations to test new healthcare facilities: a proactive and innovative approach to healthcare system safety

Element/area

Findings

Recommendations

Actioned

Provider/team issues provider

Roles and scope of practice

Emergency department (ED)

Med Surg

OB units

• Trauma room/code team formation physicians, respiratory therapist and paramedics in code room, overlapping skill set and roles.

• Team composition—addition of health care aid (unregulated) to units lack of understanding of scope (too much to little), partnership with RNs, lack of acute care hospital experience.

• Simulation teamwork training for identifying leader, role clarity, and communication.

• Simulation teamwork training/orientation classroom for role clarity and communication.

• First year post-opening focused on team simulations. Elimination of paramedic role

• Monthly simulation with IP teams continue in trauma bays

• OB Sims monthly nursing

 

• No OB on site until September 2014/ ED open January 2013.

• Expand NRP training to ED staff.

• Need for precipitous delivery equipment and supplied in ED staff.

• OB orientation day for ED occurred December 2012

• Equipment and supplies arrived prior to opening

Clinical proficiencies

Inpatient units

ICU code team

• Medications—code team unable to access automatic dispensing cabinets on units.

• No crash carts/defibrillators/code team prior to January 2013.

• Orientate nursing staff on role in accessing meds for code team.

• Development of airway buckets pre ICU with AED training for staff.

• Protocols placed in high acuity areas

• Completed

• Airway buckets in effect from 2012 (dismantled with full operation of ICU operational in 2013)

• Signage/resources created

Facility issues

All units

OB

• Code Red/Blue/power outage outside of fire department override during Code Blue; code team over team to use the stairs.

• Dedicated OB elevators/OB 7th floor OR on 3rd floor

• Awareness, key to be given to facilities management

• ID need to transfer sled to transport OB patients in need of STAT C-section/OR resuscitation

• Need for C-section set up on 7th floor

• Key obtained

• Site wide fire drills maintained yearly

• Transfer sleds obtained

• Confidence in elevators/system—not completed

Communication

Inpatient units

ICU code team

Public areas

• Mis-wiring of Code Blue/staff assist buttons

• No cell service/outside telephones in hallways for calls on site prior to mid-August 2012

• Immediate follow-up with vendor and facilities management

• Staff awareness campaign for accessing hard-wired phones locations

• Wirings fixed and tested prior to opening

• New phone lines for main street kiosks

Unintended consequences

EMS

• EMS not aware of how to access hospital for pre ED opening

• Tours for all Calgary EMS providers to site

• Completed by October 2012

Emergency department

• Code room setup, pillars hinder access to med cupboards.

• Reconfiguration of carts and trauma room to better serve needs

• Re-configuring and changing of supply carts and resources completed

Adolescent mental health

• Asphyxiation/hanging of mannequin in simulation accomplished in high observation unit

• Management and staff awareness for need to constant observation, patient placement

• Grates fixed by FM and E, staffing and patient assignments changed

Pediatric outpatient clinic

• Pediatric Code Blue lack of pediatric supplies for code blue. No medications available in clinics, lack of specialty knowledge for pediatric crisis

• Identified need to “pack and go” to trauma bay in ED ASAP, meds added to RT outreach bag, stretcher brought to unit for potential transfers

• New pediatric backpack and supplies

• Assigned situational role to ICU nurse to recommend when transfer needs to occur