Drills & Simulations for Women's Health Office Setting

Office Simulations and Drills: Part of a safety culture in the office

Office simulations and drills are intended to assure that all staff are able to perform their roles and provide needed equipment and support in common or rare emergencies.  Hesitation or delay can lead to adverse outcomes for patients.  Often times, significant gaps are identified by going through the motions and actions of an office emergency.  The 2010 Report of the Presidential Task Force on Patient Safety in the Office Setting recommends holding drills and simulations quarterly. This is the standard followed by the SCOPE program.  Areas to consider for drills include vasovagal episode, local anesthetic complication, cardiac event (myocardial infarction), allergic reaction, uterine hemorrhage, respiratory arrest, excessive sedation, and others that you may draw from experiences in your office.  You may want to keep a log of attendees to be sure that all staff attend key drills over time.

To set up a drill/simulation:

  1. Define the “story.”  It can be as simple as:  “This will be a 28 year old who is 32 weeks pregnant and has not been eating or drinking today and has a fainting episode as blood is being drawn.”
  2. Decide who in the practice makes a good “thespian” for the patient, and let them think through the symptoms and actions they will portray.
  3. Each practice can decide if the simulation or drill is announced in advance or not; both approaches have value.  It is essential for everyone to understand that the drill is “real”— that all must react as they would in a real emergency.   Only by doing this will the group be able to observe and debrief to improve patient safety in the office.
  4. Run the drill and set up time afterwards for debriefing.  This is perhaps as important as the drill itself as it reinforces the idea that you are a team, and teams learn together.
  5. Debriefing:  Let each member of the team observe areas of opportunity for improving the response in a ‘no fault’ framework.  For example:

    I noticed that you were not able to reach the cord or summon people without calling out because you had to hold the “patient” in place

    I noticed that none of us looked at the pupils to see if they were reactive when assessing the patient

    We had a hard time locating X drug, even though the emergency box was open

    We had a hard time finding the right syringe to administer

  6. This is an opportunity to reinforce the feedback loop within the team: Honest observation, appreciation of all participant input, and encouragement to continue this type of observation and shared problem solving for areas that might be considered “near misses” is a desired and valued part of the office culture.

    I nearly gave the wrong medicine

    I nearly gave the wrong dose

    I nearly gave the wrong patient information

  7. Summarize the opportunities and follow-up procedural, structural, and training plans.
  8. Revisit the drill and consider doing one without announcing it to see if the changes have addressed all the gaps in managing this emergency in the office.
  9. Keep up the learning by repeating the drill quarterly.  Repetition is key to assuring that the lessons learned are retained, but also new observations and lessons can be discovered each time a simulation or drill is run.

SCOPE Drill Video Library

The Report of the Presidential Task Force on Patient Safety in the Office Setting states that, "mock drills are a powerful way to ensure that all members of a patient care team are coordinated in the care of that patient". The SCOPE Drill Video Library is a Congress designed initiative that will provide Fellows with tools for conducting patient safety drills in the office setting.