A Simulated Lesson

Originally posted on 5-25-2010:
Last week I attended the National Patient Safety Foundation (NPSF) Annual Congress.  It was a good experience, and I plan to share some of what I learned in the next few entries. The main reason I wanted to attend was to see the simulation labs the conference was facilitating.  I have always found medical simulation intriguing as it provides a safe environment to test clinical procedures.  It is also the ideal way to test how well new technology fits into clinical workflows. I like to think of it as the healthcare equivalent of training pilots in flight simulators.  I did not realize a couple of the simulations were going to provide an enlightening experience for me.

The first simulation I went to was demonstrating how to user test new medical devices.  The setup had a state of the art patient simulator, a monitor, and an IV pump.  After sharing my human factors engineering background, the facilitators thought I would be an ideal candidate to run through the simulation.  My job was to act as the nurse taking care of "Mary", a pregnant woman that was anemic with high blood pressure.  While keeping Mary at ease, I simply had to load and administer two units of blood and a blood pressure medication.  I think using the word disaster was an understatement for what happened next.

Everything was fine at first.  "Mary" was nervous, but I was able to explain what I was giving her and why.  I'll admit I thought it was silly to talk to a dummy that was talking back to me via one of the facilitators.  I knew it was part of the whole scenario and I played along with a smile.  I turned to the pump to load the first unit of blood. Well...I would have loaded the first unit of blood if I could figure out how to load the pump.  As I switched between staring at the pump helplessly and trying anything to load the IV bag, Mary started to wonder if I knew what I was doing.  Did you know some IV pumps have a Load button to open a port to run the medication?  Thankfully after 5 minutes of sweating it out and listening to Mary complain, the facilitator pressed the button that was not located near the loading port.

Okay, a slow start.  I could figure out the programming piece to choose the right infusion rate for the unit of blood.  I looked through the list of drugs to find the selection for blood.  To my frustration, there was not a selection for "Blood".  I made the selections that seemed correct to me and was ready to deliver the first unit of blood.  The facilitator intervened at this point to inform me I made the wrong selection while Mary was starting to get dizzy and nauseous. I did not realize that there was an acronym for the unit of blood that I had missed.  This was starting to go poorly.

The facilitators recruited a nurse who was watching the spectacle to help me out.  She admitted that she had not been in a clinical role for 15 years, but would do the best she could to help get through the scenario.  The blood was finally getting delivered, so we focused on the blood pressure medication.  While getting the medication programmed in, the pump started to alarm.  Now what?  The alarm message stated, matter of factly, that air was in the line as the blood IV bag was already empty from the rapid infusion rate I programmed in.  What a chaotic scene this turned into.  Other nurses were tending to Mary who was complaining about something, the IV pump was blaring at me as I struggled to find the alarm silence button, and I was in a full sweat accomplishing nothing.  In my panic I wanted to yell at the pump and tell Mary to shut up...which thankfully I did not do. I was not exactly smiling at this point.

Mercifully the facilitator pressed the alarm silence button which was located on the top of the pump, which I thought was the power button.  He calmly helped us finish the scenario, and Mary ended up being fine.  I'm sure she never wanted to see me again. The group running the simulator thanked me for being a good sport, and letting them have some fun at my expense.  I'm sure it was funny for someone else to watch me struggle through the scenario, and I can admit to finding it humorous now.  I think a conference rep was snapping pictures, so there probably is documented evidence of my not so fine hour.

Ten minutes later the adrenaline was still pumping pretty hard.  I got so caught up in the frustration that it felt real.  I felt like I had really failed and put a patient at risk...even though I knew it was simulated experience.  That's when it hit me.  Is this what nurses go through? Are these the same feelings and emotions that someone on the front lines feels when they are frustrated by technology they need for patient?  What if I was a float nurse or new to a hospital and had never seen that pump before?  I walked in the shoes of a nurse for 20 minutes (I swear it felt like 2 hours), and it gave me a greater appreciation for what they deal with and what they do.  I also realized how important my role is designing healthcare software so it doesn't cause any confusion in a critical moment. The simulator provided a moment of enlightenment.  I had to be in that moment to really understand what a care giver is thinking and experiencing.  And yet, that scenario was only one of many tasks to be safely and successfully completed.

I attended another simulation session later in the day that was also eye opening.  I'll touch on that experience in my next entry.  Stay tuned...