Imagine Going Further with Simulation: Frontline Needs Assessment, Diagnostic, Design, and Evaluation.

Abstract :

Background: Severe infusion reactions (SIR) to chemotherapy can have a quick and unpredictable onset that can be fatal. Needs assessment surveys/interviews with frontline oncology registered nurses (RNs) highlighted a lack of confidence in the ability to manage SIRs. Protocol non-use during a SIR, lack of defined roles, and variations of managing a SIR event were noted.

Description: The project goal was to use simulation to improve RN care delivery during a SIR. Informed by our needs assessment, the curriculum design addressed SIR gaps identified by RNs. RNs participated in managing the reaction based on current skills. Then a debrief occurred, where the RNs self-identified gaps in knowledge. Debriefing reviewed medications, protocol, communication, transfer of care, and RN roles. Simulations were repeated until mastery, allowing RNs to apply their learning before returning to clinical practice to improve their next SIR patient outcome.

Characteristics: All cancer center treatment RNs (N=43) with varying experience levels were included in the immersive simulation training.

Evaluation: Pre and post-simulations showed an improvement in crucial SIR protocol interventions. Surveys revealed that RNs expressed increased confidence in communication, roles, leadership, protocol use, and medication administration.

Conclusion: Simulation can help establish a clear clinical pathway through a user-centered checklist with clear roles and tasks, which is essential in delivering efficient, safe, and timely care. The process of frontline input to inform curriculum build and training is vital to develop simulation training that transfers to the bedside. In addition to training, simulation can inform/check processes and protocols and standardize care.