LEARNING AND DEVELOPMENT


died. The latter reflects the fact that sometimes patients do not survive despite everyone’s best efforts. This is often the main cause of anxiety among laboratory staff and can weigh on the minds of biomedical scientists for weeks after the event.


Exercise design There are two roles in the exercise, the Dice Master, who must be a biomedical scientist, and the Architect, who can be any laboratory worker including managers. The cost is minimal as only paperwork


and time are required (the dice came from a Christmas cracker). There is no set-up time, and no requirement for input or supervision from a training officer or senior biomedical scientist. The dice outcomes have been formulated


to reflect the types of patient seen at Charing Cross Hospital and also to cover rare circumstances. The two-sample (group check) rule is also incorporated. The inspiration for the format came from


watching The Big Bang Theory (‘The Wiggly Finger Catalyst’ Episode 5, 4. E4, November 2011).


Reflection The reflective sheet completed after the exercise allows the participants to consider good and bad practice, and whether the exercise has increased their familiarity and confidence in dealing with major haemorrhage. It then asks for any good ideas that could be shared with the rest of the laboratory. It also asks for comments that may help improve the exercise itself. The reflective sheet may be used as evidence of continuing professional development (CPD). All participants have enjoyed the exercise and expressed an increase in confidence in managing major haemorrhage.


Quotes taken from Dicing with Death reflection sheets


“Yes (I have more confidence after this simulation), we had an MH in A&E/ theatre and everything was handled according to plan”


“It is a very good way of learning as it refreshes your knowledge of information”


“It is a really good exercise. It should be done once every month with all members of staff”


“Yes (I felt more familiar with the protocol), it improved my confidence in dealing with different situations”


“Very good exercise for people on every level”


THE BIOMEDICAL SCIENTIST MAY 2016 Laboratory staff playing Dicing with Death. 237 Section 6: New FBC results.


ARCHITECT Narrative 6.0 – “A call is received from the clinical area to say that the FBC results are in. Throw the dice to see the results”. Question


27 FBC Result


Dice 1


ARCHITECT – Give out the 2 outcome, then read Narrative 6.1


3 Outcome


Hb 130, Plts 98 Hb 70, Plts 65 Hb 40, Plts 222


ARCHITECT Narrative 6.1 – “Think about the significance of these results. Would you call anyone to make sure they’re aware of them? If so, who? The SpR calls in and you suggest issuing some products. What do you suggest? Record your thoughts in questions 28, 29, 30”.


27 FBC Result


ARCHITECT – Give out the outcome, then read Narrative 6.2


4 5, 6


All results are fine and the patient has stopped bleeding. Stand down. End of exercise.


Despite everyone’s best efforts, the patient has died.


The doctor thanks you for all your help and says they will send any spare blood back to the laboratory. End of exercise.


ARCHITECT Narrative 6.2 – “The exercise is over, thanks for playing. The Architect and the Dice Master now need to complete one reflective sheet each then compare notes”.


Conclusions The Dicing with Death exercise works well as it appears to be able to provoke original thought. The role-play nature of the exercise uses action learning, which is one of the more robust methods of training. The overall objective of increased familiarity and confidence in the laboratory management of major haemorrhage has been achieved.


The author wishes to thank Alfred Andrade, Jaymini Patel, Malalai Sadiqzai, Parul Patel and Lloyd Noble for their help and support.


Further reading • British Committee for Standards in Haematology (2010). Guidelines on the use of irradiated components (www.bcshguidelines.com).


• British Committee for Standards in


Haematology (2004). Transfusion guidelines for neonates and older children, including 2005 and 2007 amendments (www.bcshguidelines.com.


• British Committee for Standards in Haematology (2004). Transfusion guideline for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant, including 2005 and 2007 amendments (www.bcshguidelines.com).


Further information is available from Katy Veale (katy.veale@imperial.nhs.uk) who is a senior biomedical scientist in blood transfusion at Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF. This article is based on a poster presented at last year’s IBMS Biomedical Science Congress.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60