Evaluating safety and competency at the bedside

Room of horrors simulation in healthcare education: A systematic review

OBJECTIVES

A room of horrors simulation is one tool that healthcare educators use to improve learners' awareness of patient safety hazards and other critical matters in a safe and controlled environment. This review aimed to summarize research on use of room of horrors simulation in healthcare education, examine its effectiveness, and recommend directions for future education and research.

DESIGN

A systematic review of the literature.

DATA SOURCES

Relevant publications in English were identified in PubMed, Embase, CINAHL, Scopus, and dissertation databases, and through a manual search of the reference lists of included articles.

REVIEW METHODS

The systematic review and its reporting process conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Included articles were evaluated for quality using the Mixed Methods Appraisal Tool. Two authors independently extracted data from each article, and two additional authors confirmed the accuracy of the extracted data. The "horrors" used in the studies' simulations were mapped into 13 different incident types.

RESULTS

Sixteen studies were included in the final review. All of them were conducted in Western countries. Simulation scenarios were developed based on existing resources, expert guidance, or patient safety concerns frequently reported at a particular institution. The number of horrors per scenario ranged from nine to 68, with the most common being medication-related and clinical procedure-related incidents. Participants completed a room of horrors simulation as individuals, a team, or both. When competing as a team, the team sizes ranged from two to 11. Studies reported high participant satisfaction.

CONCLUSIONS

Room of horrors simulation is a useful teaching tool for healthcare students and professionals. However, there is little conclusive evidence about the ideal composition and size of teams, and therefore this merits more research attention, as does attention to the longer term impacts on learners.

[Historical development and current demands on medical training, further and advanced training in hygiene and infection prevention]

New risks in nosocomial infections and the dramatic increase in antibiotic-resistant pathogens in healthcare facilities have pointed to the urgent need for a good education of students and practitioners in the basics of hospital hygiene and infection prevention. On the other hand in the last 10 years a large number of institutes of hygiene in universities were closed with remarkable consequences concerning the decreased education in modern hygiene and public health. A broad historical overview over the last 200 years of teaching hygiene and public health at German universities is given which was integrated into the education of medical students. Nowadays many universities do not teach modern hygiene and public health. The demand of re-establishing new institutes of hygiene by the German Medical Council is discussed. The curriculum for the formation of hospital hygienists is presented.

Contact hours, skills fairs, and competency assessment

Various regulatory agencies have indicated the need to measure initial and ongoing competency among health care workers. Yet, what is competency and how can it be measured? In reality, competency assessment is about outcomes. Maintaining and advancing our knowledge, skills, and analytical abilities is important for achieving optimal patient outcomes. Competency assessment should go beyond the act of attending lectures and skills fairs. Competency assessment should be a time when nurses can demonstrate and document their problem-solving and decision-making skills, inclusion of best practices, and evidence of how those skills make a difference for the patients they care for.