Simulation Development for Moderate Sedation—A TeamSTEPPS Approach
By: Melanie Cason
Interdisciplinary education (IPE) in a busy medical center can also be an education in coordination and “herding cats.” Beyond the mock codes that prevail, specialty departments require special consideration in simulation design development for effective teamwork experiences. Creating a bundle of simulation scenarios in an area in which one is not the content expert requires collaboration and communication across disciplines.
The credentialing of physicians and nurses in moderate sedation may be required, depending on the health care facility policy, but to provide competency evaluation without allowing for team practice and team collaboration defeats the purpose. Safe, moderate sedation requires communication, teamwork, situation monitoring, mutual support, leadership, and effective team structure—all tenets of TeamSTEPPS.
At our medical center, a review of current high-fidelity simulation scenarios in place for physician credentialing revealed a lack of inclusion of the nurse and radiology technician roles. The scenarios were modified by nurse content experts from a procedural unit to include roles for both the nurse and the radiology technician.
The revised scenarios included:
- Normal expected reaction to moderate sedation agents
- Adverse reaction, over-sedation requiring a reversal agent
- A highly anxious patient for whom sedation was difficult
Teams of three were created consisting of one physician, one nurse, and one radiology technician. Two hours (three sessions) were scheduled in the simulation lab, 6:30 am–8:30 am (expect grumbling), to allow for all to participate. The TeamSTEPPS pocket guide was provided to all participants for use during the session and supplemental online materials were provided in the learning management system. Remote broadcasting was utilized to allow those not participating to view the current simulation and be active participants in debriefing. The classes were small, with 9 to 10 interdisciplinary participants, including physicians, nurses, and radiology technicians. The length of the class was 2 hours, with the simulations lasting approximately 15 to 20 minutes and debriefing for 30 minutes. Team STEPPS guidelines were used for debriefing, which was conducted using a Plus/Delta method with a flipchart.
Evaluations had a poor response rate (electronic, of course), but based on feedback the moderate sedation simulation training was incorporated into resident/nurse training with great success. Improved efficiencies in teamwork were noted, with decreased length of stay, decreased complications, and higher employee satisfaction scores.
How can you use TeamSTEPPS in specialty areas? Remember to obtain buy-in from the administration with evaluation on return on investment of time and costs. Consider core quality measures for the evaluation of effectiveness and employee satisfaction surveys for baseline and outcome data.
This interprofessional experience would not have been possible without the encouragement and support from administration and management. Special considerations of time, scheduling, and cost were approved by medical center administration, and support was provided for implementation. Participation was mandatory, and the early morning 6:30 am sessions made it possible to have no impact on patient scheduling and care. Interprofessional practice simulation takes time, effort, and coordination, but is definitely worth it.