LEARNING AND DEVELOPMENT
Dicing with Death: a major haemorrhage simulated training tool
Katy Veale used a popular adventure game format to develop a training exercise designed to simulate blood transfusion laboratory responses to patients suffering an episode of major haemorrhage.
A major haemorrhage can be stressful for laboratory staff, especially when such events are encountered only rarely. It was felt that a tool was required which would increase familiarity and therefore confidence in such
situations. The challenge was to make each occurrence of the exercise different without set-up time and effort, Dicing with Death is based on the
dice/board adventure game Dungeons and Section 1: Circumstances of major haemorrhage.
ARCHITECT Narrative 1.0 – “You are contacted about a Major Haemorrhage, roll the dice to find out the circumstances.”
Question 1 Contact method
2 Demeanour of caller ARCHITECT – use this demeanour for the rest of the exercise
3 Gender of patient 4 Age of patient 5 Type of haemorrhage Dice
1, 2, 3 4, 5, 6
1, 2, 3 4, 5 6
1, 2 Outcome
MH call via bleep Telephone call
Calm and appears competent Calm and appears a bit lost Panicking
Male
3, 4, 5, 6 Female 1 2 3 1
2 3 4 5 6
6 Grade of clinician
ARCHITECT – Use the second option if the patient is in theatre
1* 4* 6*
, 2* , 5*
, 3*
15 years old 19 years old 35 years old A&E – AAA
4 5 6
A&E – Intracranial bleed on Warfarin A&E – Varices ITU – DIC
Stroke unit – Thrombolysed and bleeding Theatre – bleeding on antiplatelet drugs
Doctor* Nurse*
/anaesthetist /ODP
Healthcare assistant* /ODA
ARCHITECT Narrative 1.1 – “Dice Master, think about the outcomes so far, and record your thoughts for questions 7 and 8”.
236
49 years old 63 years old 91 years old
Dragons. There is a set of predefined responses to dice rolls that determine the circumstances of the simulated haemorrhage, making each exercise unique. Furthermore, the results of the dice rolls can be modified to reflect the needs of different hospitals.
Sections of eight There are eight phases of the exercise which in total last 30–45 minutes. After each section there are questions requiring the participants to think about what is special or unusual about the circumstances, and reflect on what they could do to be proactive. The following four documents are required: • Standard operating procedure (SOP) which explains the procedure
• Architect sheets that provide a narrative and give the responses to the dice rolls
• Dice Master worksheet on which the dice outcomes and the reflections are recorded
• Reflective sheet for use after the exercise.
The eight sections of the exercise are: • Initial contact and patient demographics • Transfusion history and sample availability
• Initial request for components • Real-time stock level review • Baseline full blood count (FBC) and coagulation results
• Fresh FBC results • Fresh coagulation results • Something extreme.
The causes of major haemorrhage in Section 1 reflect the patient types seen at Charing Cross Hospital. Many of these involve underlying coagulopathies requiring biomedical scientists to be aware of issues surrounding these types of patient. From Section 6 onwards the dice may
dictate that the exercise stops as the bleeding is controlled, or the patient has
MAY 2016 THE BIOMEDICAL SCIENTIST
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