Development and Evaluation of an Online Simulation Program for Patient Safety

Yagi, Machiko
Asada, Yoshikazu
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Patient safety is one of the most important health provider priorities. Medical Near-Miss/Adverse Event Information (MN-M/AEI) has been collected in Japan since 2004, from 1473 hospitals to prevent adverse medical events and promote patient safety. Many medical organizations promote patient safety in regular practice, yet providers find it difficult to apply patient safety concepts in practice. This study aimed to develop and evaluate an Online Patient Safety Simulation Training (OPSST) program based on reported MN-M/AEI data. DESIGN STEPS 1. Create the interactive screen-based online interactive program in Adobe Captivate; 2. Convert to Sharable Content Object Reference Model (SCORM); 3. Upload and store in Moodle Learning Management System (LMS). CONTENT: Incorporating Japanese MN-M/AEI data regarding a 9.1% complication rate rerated central venous catheters (CVC), the OPSST program focused on patient safety factors in the management of CVC. To simulate and assess a Medical Near-Miss/Adverse Event, the program engaged learners with a self-paced 5-challenges sequential interactive management challenge, designed in Adobe Captivate. The 5 challenges: I. Identify specific focus areas for patient safety; II. Write a brief description and drag and drop your response to each item in the challenge I; III. Embed the patient safety actions in a preformatted narrative to confirm understanding of the rationale and process of solving the patient safety problem; IV. Review real-life examples from MN-M/AEI data; and V. Repeat identification of specific patient safety focus areas from challenge 1to summarize learning and apply in patient safety practice. RESULTS One hundred and forty-one full-time working nurses aged 27-58 years completed the initial and 6-month repeat program. All participants joined a continuing education with 252h per year, including the OPSST program. OPSST program was included in the test so that we could assess knowledge retention. The questionnaire included a 5-point Likert scale and open-ended questions to collect feedback about visibility, usability, and satisfaction. Moodle LMS logs were analyzed to evaluate the appropriateness of the content as the time required. By learning log, Eighty-eight of the participants used the program multiple times. And, the mean of learning time in the initial trial was 10 minutes, and the 6-month was 6 minutes. The correct response rate in the initial trial was 72.4%, increasing to 90.7% in the 6-months. Mean 5-point Likert scale (1=Low / 5=High) ratings of visibility, usability, and satisfaction were 3.6, 3.3, 3.8 respectively. Open-ended question comments were included by several participants who had never performed CVC management who felt that they learn key points of patient safety (n = 14). Some comments indicated that the program content was difficult to use (n = 17). Conclusion This study indicated that specific patient safety knowledge outcomes were maintained for 6 months following the completion of an interactive on-demand online simulation-based patient safety module. Gagne argues (Gagne 1985) in the information processing model that it is important to rehearse or code information to establish long-term memory. This program repeated the structure including the process of problem-solving in 5-challenges. This process may have coded participant working memory accounting for the preserved memory and 6-month knowledge retest results. Our results suggest that nurses with and without experience in CVC management were able to envision and understand error situations and demonstrate correct responses in a cognitive simulation training exercise. Since the time engaged in the simulation was short, it can be inferred that the difficulty level and cognitive load were appropriate for the participants. In general, it is said that the appropriate length of e-learning content should be less than 10 minutes (Association for Talent Development Research 2017), so the program described in this study was appropriate. Regarding the usability of the program, it needs to be improved by adding explanations. References Association for Talent Development Research (2017) Microlearning: Delivering Bite-Sized Knowledge Gagné, R. M. (1985). The conditions of learning and theory of instruction. Belmont CA, Wadsworth Pub Co.
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