Practice Makes Perfect—Simulation Training for Perioperative Professionals

Practice Makes Perfect—Simulation Training for Perioperative Professionals Helen Starbuck Pashley, MA, RN, CNOR Clinical Editor, AORN Michael Armacost, MA, director of simulations and innovations for the western region of Banner Health in Loveland, Colorado, discussed using simulation to improve clinical patient care during an educational session at the 57th annual AORN Congress, Denver, Colorado. Although the military and the aviation, nuclear, and mass transit industries require the use of simulation to train their employees because the consequences of failure are high, medicine and nursing are high-risk professions that have been resistant to using simulation. Armacost pointed out that, despite the 1999 report from the Institute of Medicine, To Err is Human, there are still nearly 100,000 health care-related deaths per year compared with less than 1,000 per year in the aviation industry. “My 80-yearold mother refuses to board an airplane and is terrified of flying, when she has a much higher chance of being killed or seriously injured when she visits her family practitioner,” Armacost stated. He identified several myths about how people learn and pointed out that, unfortunately, clinicians like to learn in “silos” (ie, isolated from others), which is not the best way to become skilled. One belief is that lectures are effective, when actually 50% of what is learned in an educational session is lost within 90 days if that learning is not put into repeated practice. For successful learning to occur, the opportunity for repeated practice must be present. New skills and knowledge are built on experience, hard work, frustration, pain, and learning from mistakes in a setting in which there will not be disastrous consequences. Very few individuals learn as effectively from success as they do from failure. The simulation program at Banner Health has both a stationary simulation facility and a mobile one. The simulation facilities are used by nursing staff members, medical providers, and family practice residents at Banner facilities as well as others outside of the hospital system. Simulation training at Banner Health has helped health care practitioners practice for cardiac arrests, surgical field fires, pediatric asthma incidents, and treating a patient with malignant hyperthermia in the OR. These simulation sessions highlight many system issues in the practice setting, and through simulation, team members improved their communication and situational awareness. Key information for staff members to accept is that a simulation provides an opportunity for safe practice and is not a test. It is hard work, and debriefing is essential. Work processes that people have been complaining about often become more obvious during simulation, especially to managers. This often improves these processes and employee performance. Armacost suggested that when using simulation, participants should assume no one has any experience with the situation; remember that once is never enough; and understand that repeated, deliberate practice is necessary for skill improvement. He also emphasized the importance of recognizing that even though managers often do not appreciate what that opportunity to practice can mean, employees should make every effort to get their support. For more information about the simulation program at Banner Health, visit http://Bannerhealth.com and select “Innovation at Banner” located under the “About Banner” tab on the top navigation bar. Originally published in the AORN Journal. 2010;91(6):669-670.

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