Thanks for the Craic, Now For DAS SMACC

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If you are a nurse working in any spectrum of the care pathway for the critically ill patient, SMACC is the conference for you. If you have just woken from a coma or stumbled into the world of the interwebs, below is a brief history and taste of things to come. For the seasoned SMACCers, you will notice a radically overhauled and ultra vibrant new website – http://www.smacc.net.au

This is a truly open conference – nobody is too “special” for a coffee line conversation. What’s more two of our editorial team (Ashley and Jesse) are proud members of the Organising Committee (of which three members are Nurses!). There are few professional development activities that make you want to go back to work and lift up those around you, start a blog or podcast or just present, teach or mentor better. In a time where much of the popular online presence for nursing is tangled up with materialism and commercial self-interest we need to step up, show ourselves as professional role models interested in evidence and research and political discourse. We need to tear down walls, form communities of practice and expand our peer group far beyond the people we work with on a day-to-day basis.


DAS SMACC


On September 3rd, the SMACC Team premiered the SMACC DUB Documentary. This 8 minute video gives a great insight into what make SMACC special – the people, the connections, the knowledge and the show!

SMACCDUB – The Craic Redux from Social Media and Critical Care on Vimeo.

 


The program and registration details for DAS SMACC will be coming very soon. Keep up to date by following @smaccteam on Twitter or like the SMACC Conference Facebook page. If you are new to Twitter or just considering dipping a toe in, check out this guide to get you Tweeting like a pro in no time. Join the conversation!

Goal Directed Simulation at TTC Downunder

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On July 13th we will be facilitating a super-charged techniques of simulation workshop to some brilliant clinician educators at The Teaching Course Downunder. In order to maximise our 4hrs together, we have curated some of the best FOAM simulation resources available.

Learning Objectives

1)      Participants will learn how to identify opportunities for quality improvement that may be addressed through simulation.

2)      Participants will learn how to manipulate stress to optimise learning outcomes in simulation.

3)      Participants will learn the importance of pre-brief and debrief in simulation and how this differs between workplace and simulation centre course.

4)      Participants will learn how to enhance the psychological realism of simulation.


homeworkThe course participants are asked to complete the following exercise in readiness for the workshop: SMART Goals for Simulation. We will be reviewing and discussing examples in the small group break out sessions.


The sessions will include:

Goal Directed Sim – Jesse Spurr & Clare Richmond

Titration of Stress – Chris Nickson

The Fiction Contract – Confederates, Acting and Simulated Patients  – Clare Richmond & Will Sanderson

Pre-brief – the Foundation of Safe and Effective Sim – George Willis & Jen Williams

Debriefing Q&A Panel – George Willis, Clare Richmond, Jen WIlliams and Ross Fisher – moderated by Jesse Spurr

#FOAMed


General Overview of In Situ Goal-Directed Sim

Injectable Orange –  Simulation Basics – Back to the Future Podcast

St Emlyn’s – Top Ten Tips for In Situ Sim Blog and Podcast

Injectable Orange – Tips for Team Simulation blog

ICN — Guerilla Sim: Anyone, anytime, Anywhere (Jon Gatward’s talk at SMACC 2013)

LITFL CCC — In situ simulation (overview of pros and cons and safety issues in in situ simulation)


Building Fidelity in In Situ Simulation – Fiction Contract

Injectable Orange – Plants in Simulation Vodcast

St Emlyn’s – Actors in Simulation (Nice review of Natalie May’s simulation experiences at SWEETs 15)

KI Docs — Tim Leeuwenburg’s excellent Simulation apps review

Sanko et al Establishing a Convention for Acting in Healthcare Simulation


Titration of Stress in Simulation – Stress Inoculation

SMACCUS Stress Inoculation Training – Intro podcast from the Swami

Life in The Fast Lane – Review of Stress Inoculation Training workshop + resources a plenty

EMCrit – Stress Inoculation Training (a brilliant post from Mike Lauria)


Pre-briefing and Debriefing – The Bread of the Sandwich

Jenny Rudolph and Harvard Sim Team – Establishing a safe container for learning in simulation: The role of pre-simulation briefing – Journal article 

iTeachEM  Thorough Vodcast overview of Simulation Debriefing from Sim expert Danielle Hart

St Emlyn’s – A great blog on real world Debriefing from Natalie May – not specific to simulation, but incredibly applicable to In Situ sim.

MobileSim – Excellent blog resource on Debriefing with a great structured approach to In Situ Sim debrief

Injectable Orange – Debriefing: a little carrot, a little stick – blog with quick beginners guide tips for debrief.


In Situ Simulation Resources for Quality Improvement

MobileSim –  MobileSim (Jon Gatward’s excellent in situ simulation website including guides, templates and scenarios

INTENSIVE – ICU-IS-SIM (resources for the in situ simulation program at The Alfred ICU, including scenarios)

EMSimCases – EM Sim Cases(ever growing repository of free peer-reviewed simulation cases)

SMACCDUB – Leave the Sim Lab Behind Workshop Scenario Template (Template optimised for In Situ Simulation)

Clinical Trials Worth Knowing – CRICU Sepsis Nursing Workshop

This post is a collation of references and resource material from my second presentation in the inaugural Caboolture Redcliffe ICU Sepsis Workshop for nurses. The objective of this session was to work through critical appraisal of 5 prominent critical care trials with particular significance to our practice context. The completely unambiguous overtone of this session was to practice critical appraisal and engage with the literature that informs the medical decisions in our ICU.


Following a brief introduction and overview of the constructs of evidence based practice and grading of evidence, I lead the group through a structured critical appraisal of the SPLIT Trial (Young et al 2015). We used the Critical Appraisal Skills Programme (CASP) Randomised Contol Trial (RCT) Appraisal Tool to dissect the study. Following this, the participants were broken into four small groups and each given a prominent sepsis trial to appraise and feedback to the whole group in 30 minutes time.

The trials were purposely selected for discussion as they all hold specific relevance to practice in our ICU. These trials also share one commonality – they were all ‘negative’ or no difference trials. One key aspect discussed was the importance of no difference trials. During the group feedback particular focus was drawn to identifying the Population, Intervention, Comparison and Outcome (PICO), whether the study was believable (internal validity and biological plausibility), and whether it should change practice or confirmed our current practice.

About 20 minutes into the appraisal activity the groups were provided with the Bottom Line review for their relevant study to aid in synthesising final feedback and as an example of an excellent critical appraisal. The Bottom Line is an excellent critical appraisal and literature resource for Intensive Care. Founded by members of the Wessex Intensive Care Society and now with international authorship, this is one of my absolute go-to resources to help filter and process the swathe of ICU trials.

Primary Literature

Secondary Appraisal

HEAT Trial – Acetaminophen for Fever in Critically Ill Patients with Suspected Infection (Young et al 2015) Bottom Line on HEAT – Steve Mathieu
ARISE Trial Goal-Directed Resuscitation for Patients with Early Septic Shock (Delaney et al 2014) Bottom Line on ARISE – Steve Mathieu
CORTICUS Trial – Hydrocortisone Therapy for Patients with Septic Shock (Sprung et al 2008) Bottom Line on CORTICUS – Duncan Chambler
BLISS Trial – Beta-Lactam Infusion in Severe Sepsis (BLISS): a prospective, two-centre, open-labelled randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis (Abdul-Aziz et al 2016) Bottom Line on BLISS – Adrian Wong
SPLIT Trial – Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit (Young et al 2015) Bottom Line on SPLIT – Adrian Wong

Anthony Crocco from Sketchy EBM – How to read (most) research papers


Detecting Sepsis in 2016 – CRICU Sepsis Nursing Workshop

This post is a collation of references and resource material from my first presentation in the inaugural Caboolture Redcliffe ICU Sepsis Workshop for nurses.

The objective of this talk was to provide an update on triage and screening for sepsis, the current International standards and how this filters into ongoing refinement of diagnosis and treatment in our ICU.


JAMA Network Consensus Definitions for Sepsis and Septic Shock


Primary Literature:

Secondary Sources:

Extra Reading:

Social Learning for Educators


This blog post was created for and during the Social Learning for Simulation Educators workshop at the Laerdal SUN Meeting Sydney 2016. Here are the fabulous editorial team.

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Some great simulation education blogs:

Extensive collection of simulation content resources from Injectable Orange

Simulating Healthcare – blog by Paul Phrampus

The Simulated Man – blog by Pete Dickens, Swedish sim technician

EM SIM Cases – Peer-reviewed clinical simulation scenarios


References

ICENET – Personal Learning Networks: A hack to maintain competence 

Teaching Course Podcast – Personalised Learning Networks

ICENET – Building effective communication networks: Part 1

Injectable Orange – Lose the egg: take off on Twitter