C3 - 06: IN-SITU SIMULATION FOR INTRAOPERATIVE FIRES: AN APPROACH TO ENGAGE INTERPROFESSIONAL TEAMWORK
Danita Burch, RN, MSN1, Cynthia L Leaphart, MD2; 1UFHealth Jacksonville, 2University of Florida College of Medicine Jacksonville
Background: Intraoperative fires are rare, dangerous events that debilitate patients and devastate team members involved. Individual members of the surgical team control different components of the fire triad thereby requiring effective communication for prevention and response to fires. To improve this process, we hypothesized that use of an in-situ model for team training of intraoperative fires would improve team communication and enhance performance of interprofessional teams for preventing fires and responding to fires, if they occur.
Methods: Root cause analysis of intraoperative fires and burns was performed to delineate opportunities for improvement. An in-situ simulation model for electrical and chemical intraoperative fires was developed with attention to response elements required for each member of the team (Anesthesiology, Perioperative Nursing, Surgery). Didactic and in-situ training were combined with introduction of fire safety scores and preventive or reactive response in the surgical time out. Two years of fire drills (2015-2017) with ad-hoc teams and unannounced audit of practice incorporated the training into daily practice. Ad-hoc teams were called to the OR for unannounced fire drills where knowledge of the fire triad and response to either electrical or chemical fires was assessed by trained observers.
Results: Didactic training with in-situ simulation was performed for all surgical teams through Institutional Patient Safety Training annually. Results of ad hoc fire drills and audits provided opportunities for knowledge reinforcement of the fire triad and appropriate response to intraoperative fires. Of 106 unannounced audits between May – July 2017, verbal scoring of fire risk was completed in 100% of observations. Team participation and alternate actions were verbalized in 99% of the cases. Assignment of team member duties in response to fires was verbally announced in only 28% of the cases, indicating opportunities to improve teams’ reactions if a fire were to occur.
Conclusions: In-situ simulation improved interprofessional team training for fire prevention through the creation of new training methodology for communication skills of team members. Conversion of knowledge from a simulated environment to daily work environment improved team performance. Additional opportunities exist in daily work environments to assign duties for response to intraoperative fires.