Utilising in situ simulation within translational simulation programmes to evaluate and improve multidisciplinary...

The prevalence of paediatric anaphylaxis is rising in Australia. Treatment requires timely administration of intramuscular (IM) adrenaline. Study goals included utilising in situ simulation (ISS) within a translational simulation (TS) programme as a diagnostic tool to identify the frequency and cause of IM adrenaline errors in a paediatric ED, and utilising ISS to evaluate multidisciplinary emergency team response to anaphylaxis.

A prospective observational study was conducted in the Royal Children's Hospital Melbourne ED utilising an ISS anaphylaxis scenario with a debrief pro forma within an established ISS/TS programme.

Twenty-three anaphylaxis ISS were delivered over 16 months. One hundred and sixty-four multidisciplinary staff participated (mean of 8 per session). Median times (in minutes) for the total ISS were 12:33 (interquartile range [IQR] 9:06-15:19), consisting of the scenario 4:07 (IQR 3:33-4:44) and debriefing 9:00 (IQR 5-11). IM adrenaline was administered in all ISS within 5 min, median 2:57 (IQR 2:30-3:40). Adrenaline medication errors occurred in 30% ISS (7/23). Errors included three (13%) administrations and four (17%) potential or 'near misses' associated with a verbal order or medication preparation error. A weight-based medication cognitive aid was utilised in 56% (13/23) ISS but was not utilised in all three administration errors.

ISS within TS programmes was successfully utilised as a diagnostic tool in identifying that medication errors were common during anaphylaxis management in the ED. Improving access to adrenaline in dosing boxes and promoting the utilisation of weight-based cognitive aids alongside ISS education will likely reduce errors and improve patient safety.