If you have been listening to the radio or watching television lately, you have probably heard the following statements concerning the recent outbreak of Ebola in Dallas, Texas:
- “Not correctly entering information in an electronic records system to inform healthcare professionals that a patient had traveled from an Ebola stricken region…”
- “Not adhering to the appropriate protocols for putting on and taking off personal protective equipment …”
- “Personal protective equipment was not available/did not fit the healthcare professionals caring for an Ebola patient in Dallas, Texas…”
- “Healthcare professionals not being given adequate training on Ebola…”
When a true root cause analysis of this problem is conducted, we can already predict that there will be more than a single cause, and as problem-solving professionals know, the true causes are rarely “human error” or “training.” The most appropriate action to prevent recurrence of similar problems will not be to discipline the staff; put everybody back through existing training; or even to hold another information session. Given the issues referenced above, it is clear that we have an opportunity to step back and look for the obvious places we can improve the ability of our healthcare professionals (HCP) to protect themselves and others from communicable diseases.
One area that has received a lot of attention is personal protective equipment (PPE). PPE, as defined by the Occupational Safety and Health Administration, or OSHA, is “specialized clothing or equipment, worn by an employee for protection against infectious materials.” PPE is a catch-all phrase that refers to equipment such as suits, booties, gloves, respirators, gowns, and several other elements that should be worn when working with people that may have an infectious/contagious disease. As of today, it’s still unclear as to what actually happened in Dallas that might have resulted in two nurses becoming infected with Ebola. In fact, you might say it is a “bone of contention” at the moment. In another article, one of the nurse’s family members is quoted on 10/19/2014 as saying:
“In no way was Amber careless prior to or after her exposure to Mr. Thomas Eric Duncan,” the family said.”
Another news article quotes the National Nurses United, the largest union of registered nurses in the country, as saying that more than 80 percent of nurses the union surveyed have not been given adequate training on Ebola.
As Learning and Development professionals, we should especially be interested in the following highlights taken from an article titled, How does an American nurse contract Ebola?
- The Ebola treatment protocols are complicated.
- The checklist provided is currently 21 items long.
- There are full sections on the gloves, and the gowns, and the face mask—each with multiple steps.
- There are “ifs” and “thens” and asterisks to better define terms. There’s a big caveat at the bottom about what to do if the checklist fails and hands get contaminated, but nothing about other body parts.
- There are additional pages that describe alternative ways to remove gear, with no clear preference expressed for when which method should be used.
The article goes on to say the CDC introduced a 49 slide PowerPoint detailing how to select, put on and take off personal protection equipment. The projected PowerPoint time of 45 minutes in the total presentation time of 60-120 minutes far exceeds best practices for adult learners in the area of optimal retention. Imagine trying to remember all of this while at the same time trying to treat a patient! A lot of this information is knowledge-based but very little is focused on the skill development side of the equation. Formal “training” on its own is not adequate to ensure proficiency and on-the-job competency.
If we are lucky, the Ebola fire will fizzle in this country, but everyday our healthcare system will continue to be challenged in Urgent Care Centers and Emergency Rooms as very ill patients seek help. Flu season is just around the corner and even those of us who are not HCPs know how contagious the flu is. With easy access to travel across the world, we can no longer feign ignorance and remain in denial that any particular disease occurs only “over there.” In response to this crisis, USAID and partners have launched Fighting Ebola: A Grand Challenge for Development to help healthcare workers on the front lines provide better care and stop the spread of Ebola.
As Learning and Development professionals, we must move beyond providing information exclusively via traditional avenues including PowerPoint presentations, data sheets, and complex papers. It is time to support our HCPs with better work tools to help them focus on the critical elements they need to integrate into their way of thinking about situations and then help them to apply that information. Continuing to provide information without ensuring consistent, sustained modification of work behaviors will only lead us back to another health crisis.
With that in mind, I wanted to create something for the Articulate Rapid Response Training: Ebola Outbreak (Challenge #54) that might be useful for the industry as a whole and would allow HCPs to practice selecting the appropriate personal protective equipment (PPE). In this challenge I have tailored the information to a particular role: The Primary Care Nurse in a hospital ER.
If you want to watch the demo, click the image below. If you want to learn more about how the demo is structured, continue reading.
How was this demo constructed?
When the learner launches the demo from the start screen (see above), they are immediately taken to a scenario. In this demo, the learner will be playing the role of a Primary Care Nurse. These individuals are responsible for evaluating patients after they have been seen by a Triage Nurse.
After reading the scenario, the learner is asked to select from a list of patients that are currently waiting to be seen. There are currently six patients included in this demo but only one is active…Greg. Each of the patients will present a different set of symptoms that will require the learner to make decisions regarding the minimal, most appropriate PPE to be donned before entering the exam room. These symptoms might suggest something as minor as the common cold or as infectious and as fatal as Ebola.
Once the learner selects a patient, they can learn more information about them by viewing their Patient Record. Information the learner finds here includes: what conditions the patient reported to the Triage Nurse, vital signs (temperature, blood pressure, heart rate, respiration), and other miscellaneous information. The learner should read this information closely. It’s important that they have a good understanding and assess the level of risk with this patient before they select their personal protective equipment and enter the room.
After the learner feels confident they understand the potential risk(s) they are facing with this patient, it’s critical they select the minimum and most appropriate personal protective equipment prior to entering the exam room.
After clicking “Select your PPE before examining this patient”, the learner is taken to the next screen. Here, they are tasked with choosing the minimum and most appropriate PPE required for examining this patient safely. I’ve programmed this screen so the learner must be precise in their choices. Once they choose an item, they CANNOT change it. Real life: No pressure right? Once the learner has selected the appropriate PPE for the patient, they click the “Put on PPE” button.
Now, it’s time to see if the learner selected the most appropriate PPE! Remember, the learner is about to enter an exam room with an individual that may have a common cold, influenza or even worse…Ebola. Click the door and let’s find out if the learner made the right decision!
To simplify this demo, I did not want to go through the entire examination process. Instead, I wanted to let the learner (e.g., the Primary Care Nurse) practice reading the background on a patient and then determine if they could apply their existing knowledge by selecting the appropriate PPE.
After entering the exam room, they will be taken to the assessment dashboard (see below) where they will be able to compare their PPE choices with those recommended for this specific patient. The recommendations are based on current OSHA and CDC standards. If the learner clicks each of the items under the Recommendation(s) column, they will see an explanation as to why these items were appropriate for this patient. They will also learn what the final diagnosis was for the individual.
If they select the icons under “Your PPE selections are shown in BLUE”, they will get a brief explanation for how and when each item should be used. Explanations will appear under the “Additional Information” column when each item is clicked.
In some cases, the learner may select additional PPE items that are not required. To provide further feedback for this situation, I’ve added an option (see the PURPLE icon in the bottom right hand of the screen). Selecting this option will provide additional information as to why additional PPE was not included in the recommendations for this specific patient.
Are you ready to get started? Click the image below to launch the demo.