Following participation in mock drills to facilitate implementation of an initiative to address a range of patient-related emergency situations that could potentially occur at an ambulatory oncology clinic, surveys of staff reflected a large increase in level of comfort with respect to handling a clinical emergency. The findings from this study, along with a description of the medical emergency program, were published in the Clinical Journal of Oncology Nursing.
Approximately 80% of oncology care is currently administered in an outpatient setting. Given the potential for life-threatening complications associated with cancer care to develop, as well as the high prevalence of some comorbidities (ie, hypertension, heart disease, diabetes) in the population of patients with cancer, “health care teams in the outpatient healthcare environment must be prepared for a variety of medical emergencies to ensure optimal outcomes for patients,” the study authors opined.
Described in this article is a medical emergency initiative that was developed in 2016 at an outpatient facility of Memorial Sloan Kettering Cancer Center located in Basking Ridge, New Jersey. This initiative, called medical emergency response team (MERT), involved establishment of an emergency team along with an emergency equipment cart on each floor of the center. The MERT team includes participation by leadership in nursing and administration, as well as “an infusion charge nurse, a symptomatic care clinician (SCC), an SCC physician, an oncologist on call, and plant operations staff,” the study authors noted.
In 2017, a team of nurses from 4 different departments — infusion, medical oncology, dermatology, and surgical oncology — was formed with the aim of developing a simulation-based program to educate both clinical and nonclinical staff on implementation of the MERT initiative.
Staff participation in the 20-minute emergency drills was voluntary and involved staff members actively working together during a mock clinical emergency scenario that mirrored one that had previously occurred at the outpatient center, such as “seizure, fall with and without injury, respiratory distress, stroke, vasovagal syncope, sepsis management, suicidal ideation, elder abuse, and use of the evacuation chair.”
In describing the mock drills, the study authors noted that a key element is that any staff member can alert the MERT team, but participants also “identify role assignment, obtain emergency equipment” and “manage the plan of care needed for the specific emergency being practiced.”
They also emphasized that “whenever possible, staff are encouraged to use equipment that they may be unfamiliar with, such as portable transportation units, bag valve masks, or evacuation chairs.”
These drills were immediately followed by a debriefing session where participants could provide feedback on their experiences.
Of the 155 evaluation forms distributed to drill participants following a mock drill, 84% were returned (n=130). Participants included “[nurses] (n=86), patient care technicians (n=29), administrative support staff (n=15), advanced practice providers (n=15), security/valet staff (n=4), physicians (n=3), and social workers (n=3).”
Of note, approximately 85% of participants stated that they were very uncomfortable, uncomfortable, or neutral prior to the drill regarding their ability to function in a clinical emergency. However, following the mock drill, more than 90% of participants reported feeling comfortable or very comfortable with the process.
“Mock drill practice can improve cohesiveness of staff, alleviating anxiety for new staff and increasing confidence and familiarity with equipment, location, and documentation,” the study authors concluded.
LeBoeuf J, Pritchett W. Mock drills: Implementation for emergency scenarios in the outpatient setting. Clin J Oncol Nurs. 2020;23:E7-E12.