Effects of Simulation Fidelity on Health Care Providers on Team Training-A Systematic Review.

ABSTRACT: This systematic review, following PRISMA standards, aimed to assess the effectiveness of higher versus lower fidelity simulation on health care providers engaged in team training. A comprehensive search from January 1, 2011 to January 24, 2023 identified 1390 studies of which 14 randomized (n = 1530) and 5 case controlled (n = 257) studies met the inclusion criteria. The certainty of evidence was very low due to a high risk of bias and inconsistency. Heterogeneity prevented any metaanalysis. Limited evidence showed benefit for confidence, technical skills, and nontechnical skills. No significant difference was found in knowledge outcomes and teamwork abilities between lower and higher fidelity simulation. Participants reported higher satisfaction but also higher stress with higher fidelity materials. Both higher and lower fidelity simulation can be beneficial for team training, with higher fidelity simulation preferred by participants if resources allow. Standardizing definitions and outcomes, as well as conducting robust cost-comparative analyses, are important for future research.

Part 16: education, implementation, and teams: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Optimizing the links in the Chain of Survival improves outcomes and saves lives. The use of evidence-based education and implementation strategies will allow organizations and communities to strengthen these links in the most effective and efficient manner.

Computerized pharmaceutical algorithm reduces medication administration errors during simulated resuscitations.

OBJECTIVE: Medication errors involving intravenous medications continue to be a significant problem, particularly in the pediatric population due to the high rate of point-of-care and weight-adjusted dosing. The pharmaceutical algorithm computerized calculator (pac2) assists in converting physician medication orders to correct volumes and rates of administration for intravenous medications. This study was designed to assess the efficacy of the pac2 in simulated clinical scenarios of point-of-care dosing. METHODS: The study design was a within-subject controlled study in which 33 nurses from pediatrics, pediatric critical care, or critical care (mean nursing experience of 10.9 years) carried out various point-of-care medication-dosing scenarios with and without the aid of the pac2. RESULTS: Use of the pac2 resulted in a significantly higher percentage (mean [95% CI]) of medication volumes calculated and drawn accurately (91% [87-95%] versus 61% [52-70%], p<0.0001), a higher percentage of correct recall of essential medication information (97% [95-99%] versus 45% [36-53%], p<0.0001), and better recognition of unsafe doses (93% [87-99%] versus 19% [12-27%], p<0.0001) as compared to usual practice. The pac2 also significantly reduced average medication calculation times (1.5 minutes [1.3-1.7 minutes] versus 1.9 minutes [1.6-2.2 minutes], p=0.0028) as compared to usual practice. CONCLUSIONS: The pac2 significantly improved the performance of drug calculations by pediatric and critical care nurses during simulated clinical scenarios designed to mimic point-of-care dosing. These results suggest that the pac2 addresses an area of safety vulnerability for point-of-care dosing practices and could be a useful addition to a hospital's overall program to minimize medication errors.

Learning advanced cardiac life support: a comparison study of the effects of low- and high-fidelity simulation.

To increase cardiopulmonary arrest survival, the American Heart Association developed basic and advanced cardiac life support (ACLS) courses that expose participants to realistic learning situations. This experimental study compared results of two ACLS classes on measures of knowledge (content exam) and resuscitation skills (performance exam). Both the control and experimental groups consisted of physicians, nurses, emergency medical technicians, respiratory therapists, and advanced health care providers. The control group used low-fidelity simulation (LFS); the experimental group was exposed to enhanced realism via high-fidelity simulation (HFS). The findings showed a positive correlation between enhanced practice and learning but no significant correlation between posttest and skills test scores for the LFS and HFS groups. The HFS group did score higher on both cognitive and behavioral tests, but the difference was not statistically significant. Participants from both groups indicated satisfaction with their forms of simulation experience and course design. In addition, participants' self-confidence to care for a victim of cardiopulmonary arrest was increased after completing their course; profession and work experience had no effect on responses. The largest difference noted was in verbal responses to course satisfaction. The experimental group stated that learning using HFS was enjoyable and adamantly recommended that ACLS should only be taught using HFS. Further study is required to assess if practicing beyond the course enhances short- and long-term retention of ACLS techniques.