Drills & Simulations for Women's Health Office Setting

Office Simulations and Drills:  Part of a safety culture in the office

The role of office simulation and/or drills is to assure that in common or rare office emergencies, all staff are able to perform their roles and provide the equipment and support needed without hesitation or delay which could lead to an adverse outcome for our patients.  Hospital and office drills/simulations often find significant gaps that cannot be identified without going through the motions and actions of an office emergency.  For example:  the chair does not go flat because it is too close to the wall and the single person in room cannot move it with someone in it;  the oxygen tank that the supervisor knows, cannot be found by the MA who is called to help;  the emergency cord is too far away or the “system” to call (banging on wall, yelling, etc.) is not functional because most people are at lunch, or the office does not have any medications for seizure available and the 911 call will take 10 to 20 minutes to arrive, or…

The recommendation of the Presidential Task Force (For more information on quarterly drills, please see the Report of the Presidential Task Force on Patient Safety in the Office Setting, page 4 and 5.) was to hold such drills/ simulations quarterly, which is the standard that the SCOPE program follows.  Areas to consider for drills are:  fainting while blood is drawn, seizure in office, significant bleeding with procedure, in the 2^nd or 3^rd trimester, syncope/ loss of consciousness (test in room, in lobby, etc. and remember cardiac causes), child choking in lobby, Fall and confused responses, and others that you draw from experiences in your office(s).  Also, for the most common areas, you may want to repeat them every 6 months or so, as learned behaviors become extinguished without practice and repetition.

You may want to keep a log of attendees to be sure that all staff attend key drills over time. 

To set up such a drill/ simulation:

1.  Define the “story” about the drill.  It can be as simple as:  this will be a 28 year old who is 32 weeks pregnant and has not been eating or drinking today and has a fainting episode as blood is being drawn.

2. Decide who in the practice makes a good “thespian” for the patient, and let them think through the symptoms and actions they will portray

3. Each practice can decide if the simulation/drill is announced ahead or not, both have value.  The most important thing is being sure that everyone understands that the drill is “real”—that regardless of how well they know the actress, they need to use this to practice as they would react and act in a real emergency.  Only by doing this will the group be able to observe and debrief to improve patient safety in the office.

4. Then run the drill and set up time after for debriefing.  This is perhaps as important as the drill itself as it reinforces the idea that you are a team, and teams learn together.

5. Debriefing:  Let each member of the team observe areas of opportunity for improving the response in a no fault framework.  For example, I noticed that you were not able to reach the cord or summon people without calling out because you had to hold the “patient” in place;  I noticed that none of us looked at the pupils to see if they were reactive when assessing the patient;  we had a hard time locating the x drug, even though the emergency box was open, or we had a hard time finding the right syringe to administer it, etc.

6. This is an opportunity to reinforce the feedback loop within the team with honest observation, appreciation of the thoughts of all the team present, and encouragement to continue this type of observation and shared problem solving for areas that might be considered “near misses”—I nearly gave the wrong medicine, wrong dose, wrong patient information, etc. as a desired and valued part of the office culture

7. Summarize the opportunities and follow up procedural/ structural/ training plans.

8. Revisit the drill/simulation and consider doing one without announcing it to see if the changes have addressed all the gaps in managing this emergency in the office.

Keep up the learning by repeating the drill in 6 months.  Repetition is a key to assuring that the observations and lessons learned are retained, but also new observations are made with each time a simulation or drill is run.