National Survey: How Do We Approach the Patient at Risk of Clinical Deterioration outside the ICU in the Spanish Context?

BACKGROUND: Anticipating and avoiding preventable intrahospital cardiac arrest and clinical deterioration are important priorities for international healthcare systems and institutions. One of the internationally followed strategies to improve this matter is the introduction of the Rapid Response Systems (RRS). Although there is vast evidence from the international community, the evidence reported in a Spanish context is scarce. METHODS: A nationwide cross-sectional research consisting of a voluntary 31-question online survey was performed. The Spanish Society of Intensive, Critical and Coronary Care Medicine (SEMICYUC) supported the research. RESULTS: We received 62 fully completed surveys distributed within 13 of the 17 regions and two autonomous cities of Spain. Thirty-two of the participants had an established Rapid Response Team (RRT). Common frequency on measuring vital signs was at least once per shift but other frequencies were contemplated (48.4%), usually based on professional criteria (69.4%), as only 12 (19.4%) centers used Early Warning Scores (EWS) or automated alarms on abnormal parameters. In the sample, doctors, nurses (55%), and other healthcare professionals (39%) could activate the RRT via telephone, but only 11.3% of the sample enacted this at early signs of deterioration. The responders on the RRT are the Intensive Care Unit (ICU), doctors, and nurses, who are available 24/7 most of the time. Concerning the education and training of general ward staff and RRT members, this varies from basic to advanced and specific-specialized level, simulating a growing educational methodology among participants. A great number of participants have emergency resuscitation equipment (drugs, airway adjuncts, and defibrillators) in their general wards. In terms of quality improvement, only half of the sample registered RRT activity indicators. In terms of the use of communication and teamwork techniques, the most used is clinical debriefing in 29 centers. CONCLUSIONS: In terms of the concept of RRS, we found in our context that we are in the early stages of the establishment process, as it is not yet a generalized concept in most of our hospitals. The centers that have it are in still in the process of maturing the system and adapting themselves to our context.

Clinical Debriefing in Cardiology Teams: A National Survey in Spain.

BACKGROUND: Clinical debriefing (CD) improves patient safety and builds team resilience. PURPOSE: We describe the current use of CD by multiprofessional Spanish cardiology team members. METHODS: A self-administered survey exploring 31 items was disseminated online in October 2020. A comparison was made between respondents that who experience in CD with inexperienced respondents. Inferential analysis was done using Pearson's χ 2 test. RESULTS: Out of 167 valid responses, 45.5% had been completed by cardiology nurses. One-third of the respondents had experience in CD. Most common situations preceding CD were those with negative outcomes (81.8%). Time constraint was the most commonly reported barrier (76.3%); however, it was significantly less than the expectation of inexperienced respondents (92%, P < .01). Overall, only 28.2% reported self-confidence in their skills to lead a CD. CONCLUSIONS: There is a necessity in Spanish cardiology teams to receive training in CD and embed it in their daily practice.

Clinical debriefing during the COVID-19 pandemic: hurdles and opportunities for healthcare teams.

The COVID-19 pandemic and the subsequent pressures on healthcare staff and resources have exacerbated the need for clinical teams to reflect and learn from workplace experiences. Surges in critically ill patients, the impact of the disease on the workforce and long term adjustments in work and life have upturned our normality. Whilst this situation has generated a new 'connectedness' within healthcare workers, it also continues to test our resilience.An international multi-professional collaboration has guided the identification of ongoing difficulties to effective communication and debriefing, as well as emerging opportunities to promote a culture of dialogue. This article outlines pandemic related barriers and new possibilities categorising them according to task management, teamwork, situational awareness and decision making. It describes their direct and indirect impact on clinical debriefing and signposts towards solutions to overcome challenges and, building on new bridges, advance team conversations that allow us to learn, improve and support each other.This pandemic has brought clinical professionals together; nevertheless, it is essential to invest in further developing and supporting cohesive teams. Debriefing enables healthcare teams and educators to mitigate stress, build resilience and promote a culture of continuous learning and patient care improvement.

Basic life support training programme in schools by school nurses: How long and how often to train?

BACKGROUND: Cardiopulmonary resuscitation (CPR) training in schools, despite being legislated in Spain, is not established as such within the subjects that children are taught in schools. OBJECTIVE: to evaluate the acquisition of CPR skills by 11-year-old children after a brief theoretical-practical teaching programme taught by nurses at school. METHODS: 62 students were assessed in a quasi-experimental study on 2 cohorts (51.4% of the sample in control group [CG]). In total, 2 sessions were given, a theoretical one, and a practical training for skill development in children, in which the CG performed the CPR in 2-minute cycles and the intervention group in 1-minute cycles. The anthropometric variables recorded were weight and height, and the variables compression quality and ventilation quality were recorded using the Laerdal ResusciAnne manikin with Personal Computer/Wireless SkillReport. RESULTS: The assessment showed better results, in terms of BLS sequence performance and use of automated external defibrillator, in the CG and after training, except for the evaluation of the 10-second breathing assessment technique. The quality of chest compressions was better in the CG after training, as was the quality of the ventilations. There were no major differences in CPR quality after training and 4 months after the 1-minute and 2-minute training cycles. CONCLUSIONS: 11-year-old children do not perform quality chest compressions or ventilations but, considering their age, they are able to perform a BLS sequence correctly.

COVID-19 crisis, safe reopening of simulation centres and the new normal: food for thought.

BACKGROUND: The world is facing a massive burden from the coronavirus disease 2019 (COVID-19) pandemic. Governments took the extraordinary step of locking down their own countries to curb the spread of the coronavirus. After weeks of severe restrictions, countries have begun to relax their strict lockdown measures. However, reopening will not be back to normal.Simulation facilities (SF) are training spaces that enable health professionals and students to learn skills and procedures in a safe and protected environment. Today's clinicians and students have an expectation that simulation laboratories are part of lifelong healthcare education. There is great uncertainty about how COVID-19 will impact future training in SF. In particular, the delivery of training activities will benefit of adequate safety measures implemented for all individuals involved.This paper discusses how to safely reopen SF in the post-lockdown phase. MAIN BODY: The paper outlines 10 focus points and provides operational tips and recommendations consistent with current international guidelines to reopen SF safely in the post-lockdown phase. Considering a variety of national advices and regulations which describe initial measures for the reopening of workplaces as well as international public health recommendations, we provide points of reflection that can guide decision-makers and SF leaders on how to develop local approaches to specific challenges. The tips have been laid out taking also into account two main factors: (a) the SF audience, mainly consisting of undergraduate and postgraduate healthcare professionals, who might face exposure to COVID-19 infection, and (b) for many simulation-based activities, such as teamwork training, adequate physical distancing cannot be maintained. CONCLUSIONS: The planning of future activities will have to be based not only on safety but also on flexibility principles.Sharing common methods consistent with national and international health guidelines, while taking into account the specific characteristics of the different contexts and centres, will ultimately foster dissemination of good practices.This article seeks to further the conversation. It is our hope that this manuscript will prompt research about the impact of such mitigation procedures and measures in different countries.

¿Puedes aportar valor más allá de la UCI? El reto de la enfermería en los Sistemas de Respuesta Rápida / Can you add value beyond the ICU? The nursing challenge in systems of Rapid Response

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Prebriefing en simulación clínica: análisis del concepto y terminología en castellano / Prebriefing in healthcare simulation: Concept analysis and terminology in Spanish

El entrenamiento basado en simulación clínica consta de introducción, escenario y debriefing, siendo los dos últimos los más estudiados en la literatura. El objetivo fue realizar un análisis y comprensión del concepto de introducción, sesión de información u orientación a la simulación (prebriefing, briefing y orientation en inglés) existente en las publicaciones en español, y proponer una definición ampliada y una terminología para uso en la educación en salud. Se realizó una revisión sistemática en MEDES, IBECS, DOCUMED y MEDLINE usando los términos «orientación, orientation, introducción, introduction, facilitación, facilitation, briefing, prebriefing, metodología y methodology», cruzados con «simulation y simulación». Se hizo un análisis evolutivo y comprensión de los resultados con la metodología de Rodgers. De 286 artículos identificados se incluyeron 69 para revisión. Veinte (34,5%) mencionaron la introducción sin identificar formalmente esta fase, con diversas descripciones generales, o usando definiciones o términos concretos. Se propone la utilización del término introducción seguida del nombre de la fase que se está presentando en una actividad de simulación (curso, entorno de simulación, sesión teórica, caso clínico, debriefing u otra actividad) para mantener al participante orientado a lo largo de toda la sesión de entrenamiento, y apoyar la investigación y desarrollo de la simulación

Simulation based training research has focused on scenario and debriefing, being orientation to simulation less explored. However, effective learning depends on creating and maintaining an engaging learning environment. Simulation educators have to build a psychologically safe context that encourage commitment, reflection and meaningful participation. The objective was to analyse and understand the concept of prebriefing to simulation in the publications in Spanish, and to propose an extended definition and terminology for use in health education. We conducted a systematic literature review in MEDES, IBECS, DOCUMED and MEDLINE using the terms "orientación, orientation, introducción, introduction, facilitación, facilitation, briefing, prebriefing, metodología and methodology", crossed with "simulación and simulation". A concept analysis of the results was done using Rodgers methodology. Sixty nine out of 286 articles identified were included for review. Twenty (34.5%) mentioned the introduction without formally identifying this phase, with various general descriptions, or using specific definitions or terms. The use of the term introducción (introduction) followed by the name of the phase that is being contextualized within a simulation-based learning experience (course, simulation environment, theoretical session, clinical case, analysis or other activity) is proposed to keep the participant oriented throughout the session, and to support research and development of simulation