Simulated events have been used within the health care setting for some time (e.g. resuscitation training; assessment of anaesthetic performance). Most are conducted outside the practice area of the healthcare worker (e.g. skills labs/ education centres). We aim to bring many of the principles learned from the above settings into the clinical practice environment, where we work.

We have adopted the term moulage for this concept. The ECS, a medium fidelity mannequin is specifically designed to support emergency care scenarios throughout a multi-professional team in both the clinical area as well as the stand-alone simulator setting. The ECS is designed to deliver realism at the same level as can be achieved in the stand-alone simulator centre, but portable. This is the essence of WOMBATS as it allows the classroom to open up to real life situations within their own clinical area, thereby allowing participants and senior staff / management to assess the effectiveness of both the teams and policies / procedures for that specific area. Again this style of simulation is heavily linked to the clinical risk department where our scenarios are drawn from. We have been running WOMBATS, for over 4 years with good effect with participants from most grades of both medicine and nursing positively evaluating it.

Specific Aims and outcomes:
The aim of moulage is to reduce the impact of serious untoward incidents upon the mortality and morbidity of patients (as a complement to other strategies). The objectives are:

  • To promote teamworking (avoid teamwork failure);
  • To Re-inforce a standard (ABC) approach to clinical situations;
  • To provide the knowledge needed to identify: specific clinical situations (e.g. tension pneumothorax)
  • To provide a process for dealing with: specific clinical situations (to avoid the ultimate potential consequence-cardiac arrest)

Team working
Evidence from the aviation industry has identified that even the most experienced (and knowledgeable) pilot has failed to manage a critical situation effectively. We are encouraged to learn from these experiences in the health care setting (DOH 2001). It seems sensible that for a critical situation to be handled effectively, a combination of both technical skills and effective team management is required.

Specific Responses to Critical Incidents
The nature of health care provision is such that incidents occur on a daily basis, some of which have detrimental consequences (especially if action does not occur early in the courses of the incident). Many organisations have risk management strategies which identify (and hopefully aim to rectify such situations). By taking incidents (e.g. haemothorax following central line insertion, tamponade following cardiac surgery) and simulating them in the clinical practice setting (using the above objectives), teams can learn to improve upon their recognition and early treatment skills.

Education and Practice
Moulage provides practice based, realistic solutions using the principles outlined above. A combination of: simulated events; teaching; facilitated reflection (using video feedback); peer evaluation and follow up questionnaires provides an exciting and unique opportunity for all grades of staff, from all professions. DOH (2001) Building a Safer NHS for Patients Implementing an Organisation with a Memory. London: Department of Health

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