Post on 25-Jun-2018
transcript
Epworth HealthCare
Excellence. Everywhere. Everyday
Simulated Learning in Emergency
Training for HDR
Yen Tran, Thang Nguyen and Venkata Seshadri
Epworth Radiation Oncology, Melbourne, Victoria, Australia
Introduction
2
• Epworth Radiation Oncology (ERO) commenced
its HDR service in July 2013
• microSelectron® Digital afterloader
• Currently treat HDR vaginal vault patients
• Vaginal CT/MR Multi Channel (VCMC) applicator
• Standard CT/MR applicator set
Background
3
• Likelihood of the source not retracting or source
detachment is very low
• AAPM Radiation Therapy Committee Task Group
No. 59 (Kubo et al. 1998)
• All HDR Brachytherapy services have Emergency
Procedures and protocols in place
Background – Simulated Learning
4
• Epworth Clinical Simulated Learning Team
• Applied in other high-hazard professions
– Aviation,
– Nuclear power
– Military (Ziv et al. 2003)
• Rapidly developing discipline that provides safe
and effective learning environments
• Advantage is the ability to create an environment
that facilitates deliberate practice (Weller et al. 2012)
Purpose
5
• To create a simulation-based medical education
tool
• To test Epworth’s HDR emergency procedures
• To meet AAPM TG 59 recommendation of
containment in 1-2 minutes
• To provide training, feedback and credentialing of
brachytherapy staff
Methods
6
• HDR Emergency Procedures
• High fidelity simulation to accurately represent the
clinical environment
• Hybrid simulation approach
• Used a Laerdal SimMan Essential Patient
Simulator TM female pelvis mould
• HDR emergency was simulated
(Laerdal helping save lives 2001)
Results
8
• Simulation 1
• Videos\Onc Scenario 1.m4v
• Simulation 4
• Videos\Onc Scenario 4.m4v
Results
9
Simulation Role Individual
Time (sec)
Time Source
Contained (sec)
Total Time
(sec)
Simulation 1 Physicist 21 44 126
RO 87
Nurse 63
Simulation 2 Physicist 22 40 108
RO 68
Nurse 50
Simulation 3 Physicist 21 40 105
RO 59
Nurse 42
Simulation 4 Physicist 20 40 104
RO 67
Nurse 51
Discussion
10
• Debriefed after each simulation
• Identified gaps and processes were put in place to
improve emergency procedures
• Staff movement throughout the emergency
situation needed improvement
• Highlighted the importance of staff-patient and
staff-staff communication
Conclusion
11
• Successfully tested and reviewed Epworth’s
emergency procedures
• Simulation based training has given Epworth
Radiation Oncology a valuable training tool
• Source was removed and contained in less than
45 seconds in each simulation
• Total emergency response time was improved by
18%
Acknowledgements
12
• Epworth Radiation Oncology
• Epworth Simulation and Clinical Training team –
Tom Hallahan, Daniel Knoche & Tess Vawser
References
13
• Kubo, H. D, Glasgow, G. P, Pethel, T. D, Thomadsen, B. R, &
Williamson, J. F 1998, ‘High dose-rate brachytherapy treatment
delivery: Report of the AAPM Radiation Therapy Committee Task
Group No. 59’,Medical Physics, vol. 25, no. 4, pp. 375-403.
• Laerdal helping save lives, 2001. Available from:
˂http://www.laerdal.com/au/˃ [11 February 2014].
• Weller, J. M, Nestal, D, Marshall, S. D, Brooks, P. M, & Conn, J. J
2012, ‘Simulation in clinical teaching and learning’, The Medical
Journal of Australian, vol. 196, no. 9, pp. 594-598.
• Ziv, A, Wolpe, P. R, Small, S. D & Glick, S 2003, ‘Simulation-Based
Medical Education: An Ethical Imperative’, Academic Medicine, vol.
78, no. 8, pp. 783-788