P094: Use of high fidelity simulation to improve quality of care within Correction Canada's maximum security facilities: A Canada's first

Abstract

Innovation Concept: Nurses working in corrections facilities are routinely faced with acute care scenarios requiring skilled management. There are also increasing numbers of inmates with chronic health conditions and acute exacerbations. Correctional Service Canada (CSC) has partnered with the Clinical Simulation Lab at Queen's University to develop a simulation-based training program aimed at improving acute care skills of Corrections nurses and staff. This novel quality improvement program encompasses a range of presentations that commonly occur in correctional environments. Methods: The program consisted of two laboratory sessions focused on acute care and trauma followed by an in-situ simulation session. The sessions were organized around the 4-component instructional design that enhances complex learning. Both lab sessions began with scaffolded part-task training (IV insertion, ECG interpretation, airway, circulatory support, etc) and then progressed to six team-based high-fidelity simulations that covered cardiac arrhythmias, hypoglycemia, agitated delirium, drug overdoses, and immediate trauma management. Participants rated the effectiveness of each session. Lastly, an in-situ session was conducted at the Millhaven maximum security facility for nursing and correctional staff. It comprised of five scenarios that incorporated actors, a high-fidelity manikin, and simulated security issues. Participants completed a validated self-assessment before and after the session grading themselves on aspects of acute care. Curriculum, Tool, or Material: Our multi-modal simulation curriculum enhanced self-assessed knowledge of CSC learners. Of 71 attendees in the acute care skills session, 70 agreed or strongly agreed that the exercise enhanced their knowledge, satisfied their expectations, and conveyed information applicable to their practice. All 13 participants in the trauma session agreed or strongly agreed to these sentiments. We used Wilcox signed rank test item by item on the in-situ questionnaire. There was significant improvement in majority of skills sampled: airway management, O2 delivery, team organization and assessment/treatment of cardiac arrest. Conclusion: This initiative is the first time high-fidelity simulation training has been used with Corrections nurses and the first in-situ simulation in a maximum security institution in Canada. The sessions were well-liked by participants and were assessed as very effective, validating the demand for further implementation of clinical simulation in correctional facilities.