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Feature

NetworkZ: Simulation training to improve patient safety

09 March 2023
Simulation training that brings multidisciplinary teams together in real clinical settings can identify problems and break down barriers to save real lives.
Things weren’t going well in the operating room. The patient was having a reaction but the anaesthetist either hadn’t noticed or hadn’t figured out why.

A nurse noticed. Quietly, she suggested the cause of the reaction, but the anaesthetist didn’t hear. For a little while he continued along his path of care – the incorrect path – before the nurse gathered her courage and spoke up again. This time, the anaesthetist heard and changed what he was doing.

No harm came to the patient – not only because the nurse spoke up but because the ‘patient’ was a hyperrealistic simulator. The anaesthetist and nurse were real, though, as were the rest of the team. They were participating in simulation training – and the lessons they learned that day might save real lives in the future.

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What makes NetworkZ unique

“We’re constantly learning, growing and improving as a result of the feedback we’re getting from the practitioners, patients and researchers. It’s an exemplar in the translation of research into practice.”

Vanessa Ding

NetworkZ is a national programme run by the UniServices-managed (NIHI). It conducts team-based training for multidisciplinary healthcare teams with the goal of improving patient outcomes and healthcare equity.

Running since 2017 and originally focusing on operating rooms, NetworkZ has recently expanded its scope to cover more care settings and types of scenarios, including emergency wards, radiology, post-operative care and obstetrics. All scenarios are modelled on real-life situations.

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Vanessa Ding and Kaylene Henderson

NetworkZ is based on the research of Professor , an anaesthetist and the programme’s academic director. Her work has found that training health professionals to remove barriers to communication in clinical settings leads to better patient safety outcomes.

Historically, professional development has focused on single disciplines, so healthcare assistants and surgeons didn’t train together despite working together. NetworkZ was the first programme in New Zealand to bring multidisciplinary teams together for high-fidelity simulation training.

“In one debrief I conducted, a healthcare assistant talked about her role and the preparation she did, and the surgeon said, ‘I didn’t know you did all those things,’” says Kaylene Henderson, the NetworkZ programme manager. “Now she calls her by name every time she sees her. So NetworkZ is breaking down barriers and building relationships even within teams that work together all the time.”

NetworkZ is also unique in that it’s part of an ongoing research programme, says NIHI General Manager Vanessa Ding.

“It’s not based on one-off research published back in the day. We’re constantly learning, growing and improving as a result of the feedback we’re getting from the practitioners, patients and researchers. It’s an exemplar in the translation of research into practice.”

 

Learn about the courses NetworkZ offers to healthcare teams and the clinical settings in which it works
Learn about the courses NetworkZ offers to healthcare teams and the clinical settings in which it works

High realism

NetworkZ uses Laerdal SimMan 3G with realistic silicone overlays made by New Zealand company MedicFX, which started off making medical special effects for films and TV.

These sophisticated simulated ‘patients’ are a key part of the programme’s success. The simulators represent patients of a range of ages, genders and ethnicities. They can be operated upon, intubated and even undergo amputations and births.

Not only do the simulators cover scenarios ranging from stabbings to sepsis, they blink, bleed and have pulses, pupils that dilate and chests that rise and fall. They can even grunt, speak or scream through mics operated by simulation assistants observing from another room.

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The realism of the simulations is crucial to the success of NetworkZ – not only the realism of the ‘patients’ but also the fact that they take place in the real settings where multidisciplinary healthcare teams work.

“The scenarios we have are acute, rare scenarios so they push the limits of what’s possible in that setting, and that’s deliberate to ensure we’re uncovering latent safety threats,” says Ding.

One team doing a simulation injected glucose instead of saline into a simulated patient’s artery – something which, if done in real life, could have led to permanent hand damage. This led the team to redesign their storage of fluids to minimise the possibility of mix-ups.

Another team discovered during a simulation that a defibrillator wasn’t working properly. As a result, the faulty equipment was replaced within a week.

“The scenarios we have are acute, rare scenarios so they push the limits of what’s possible in that setting, and that’s deliberate to ensure we’re uncovering latent safety threats.”

Vanessa Ding

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The importance of communication

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The simulated scenarios are only part of NetworkZ training. Just as important is the debriefing process, when teams reflect on what happened in the simulation, why and identifying gaps in knowledge, systems or infrastructure.

After the simulation session where the anaesthetist initially didn’t hear the nurse, the discussion broke down barriers by allowing the nurse to talk about how hard it can be to speak up and the anaesthetist to express how much he values her contributions.

“It’s not us telling them what they did or didn’t do; it’s them reflecting on knowledge or communication gaps,” says Henderson. “They’re the ones who come up with solutions, so that makes the training more powerful and effective.”

An important aspect of NetworkZ is its focus on equity. Not only can it deliver the same quality of programme in tertiary hospitals as in small, remote ones, it is now working with Māori facilitators, clinicians and patients to understand how to better educate the workforce on equitable outcomes, says Ding.

The programme can also include discussions about withdrawing treatment when a patient has indicated they do not wish to continue beyond a certain point.

“That’s a very emotive scenario that requires discussions about equity and how to manage end-of-life care for the patient and whānau,” says Henderson.

“Fundamentally, we’re trying to reduce patient harm, and our unique model of simulation training is a very tangible and effective way of doing that.”

Vanessa Ding

The impact of NetworkZ

Henderson has been convinced of the importance of simulation training for a long time – decades ago, as an experienced anaesthetic technician, she participated in a simulation for research purposes.

“During the simulation, they put in some faults and I didn’t find one. They were right in front of me and I missed them,” says Henderson. “It made me realise we can all make mistakes and ignited an interest in simulation training.”

Henderson has been with NetworkZ since its inception in 2016. Since then, she and the team have trained more than 3,500 people nationally, plus some 600 instructors who can lead the programme independently in clinical settings across the country.

Not only has NetworkZ recently expanded the scenarios and settings it covers, it has also changed from a government-funded model to a sustainable, cost-recovery model that works in the public and private healthcare sectors. It has also begun to work internationally – so far just in Australia.

“We’re looking to scale the impact we’ve already had,” says Ding. “Fundamentally, we’re trying to reduce patient harm, and our unique model of simulation training is a very tangible and effective way of doing that.”