Pediatric surgical simulation scenarios can be incredibly effective with effort to specific and well thought out moulage for maximal impact. Although surgical complications are generally a low frequency event in pediatrics, the process for a team to recognise and respond to this high stakes event can be a great learning experience for healthcare simulation participants. This article by Erin Carn-Bennett, RN, MSN will walk through options and considerations for a pediatric surgical simulation scenario, patient and debrief points.

Scenario Stems are Important

The scenario stem or background story is incredibly important to pitch at the right level for the clinical simulation participants. The stem assists with clinical simulation participant engagement and suspension of disbelief. The stem should relate to a clinical presentation that is either common or is performed in the clinical environment that the scenario is targeted to. This article will discuss options to consider with a pediatric postoperative complication scenario.

A postoperative bleed is often an uncommonly common complication for many pediatric surgical patients. This is a complication which all healthcare workers involved in clinical care need to be familiar with in terms of assessment, recognition and management on a pediatric surgical ward. A thorough assessment of these patients and actions being taken in quick succession can have a huge impact on patient morbidity and mortality. Clinical simulation scenarios are a great environment for healthcare workers to practice, acquire and reflect on knowledge that relate to this topic.

The scenario stem given to the clinical simulation participants can be a background story of a somewhat trivial operation depending on what surgical cases are common for the clinical simulation learner group and the environment. For example a biopsy of a bone lesion for orthopedics or an appendectomy for a general surgical ward. The patient manikin should be well covered in hospital blankets so that a removal of these is required to complete a full patient assessment.

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A plan should be made from the scenario stem or at the time of the scenario delivery as to how many clinical simulation participants will be in the room at the start of the scenario. This consideration can sometimes be overlooked however can be a great opportunity for team members to be able to practice their handover skills as the patient deteriorates and an escalation of care is required. This is also a point of the scenario to take into account for the debrief also. Ideally a multidisciplinary team complement should be present to maximize the learning from the clinical simulation scenario. However, this scenario can also be run successfully as a single discipline scenario.

On initial assessment the manikin under the blankets should have vital signs which indicate that the patient is unstable and requires an escalation of care. For a pediatric patient this includes a difficulty to rouse, tachycardia, low blood pressure and delayed central refill time. The patient should not have a GCS which is too low though as to distract the clinical simulation participants from further assessment at this point.

Effective Moulage Can Have Maximal Impact

When the patient blanket is removed in order to expose the patient and perform a further assessment, moulage in the form of a Clean Bleed Mat can be present if there is access to this. The Clean Bleed Mat should already be turned on and activated to demonstrate that there has been bleeding throughout the sheets of the bed. (for maximal moulage impact and no mess!) A postoperative bleed visible through the bed alongside the clinical instability of the patient should cue clinical simulation participants to escalate the situation and call for assistance immediately. A dressing can be present where the operation was completed with some simulated blood oozed over the top of the dressing to be able to demonstrate where the bleed started from.

The clinical instability of the patient should indicate that the patient may require a transfusion of blood. This can be a great opportunity to have clinical simulation participants practice the use of blood administration with simulated blood. The involvement of blood banks as confederates in clinical simulation scenarios can be incredibly useful from both a clinical simulation participant perspective and also for blood banks as well.

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Work With The Blood Bank in Clinical Simulation Where Possible

The postoperative bleed scenario is an ideal healthcare simulation scenario to test out hospital processes and to identify latent safety threats. Simulated blood products give clinical simulation participants a great opportunity to be able to practice the administration of blood products. For many nurses the emergency administration of blood products within a ward based environment may not be commonplace. Healthcare simulation is an ideal place for healthcare professionals to be able to practice and enhance clinical skills in this area of practice.

An appropriate escalation of care and code calls are another great element to this clinical simulation scenario for participants to be able to work through in an experiential learning manner. Decisions of what actions to be made for escalation of care and at what points in the scenario are great debrief points to make note of and to circle back to. Depending on time allotted for the clinical simulation scenario, the arrival of a code team and the receipt of a handover can be a great place to cease the scenario. Otherwise, as confederates or participants that represent the code team, the arrival of more team members can become immersed into the scenario as well and allow for the scenario to continue a bit longer.

This article has discussed a case of a postoperative pediatric surgical simulation scenario which involves a postoperative bleed. This can be a highly effective scenario with some simple moulage to provide increased response from clinical simulation participants. The postoperative bleed scenario is a great opportunity for pediatric healthcare workers to be able to practice and enhance clinical skills in this area, with a number of notable debrief points which have also been captured within this article.

Read More: How to Maximize the Impact of Interdepartmental Clinical Simulation