Apparently Mozambique boasts 78 different types of snakes, 13 of which are ‘potentially deadly’,
but would Beira Central Hospital’s nurses be familiar with the childhood game Snakes and Ladders? We were wrestling with this question before heading for our final Beira project visit in November. Focus Games, (www.focusgames.com) a company making fun and educational board games for health professionals, had kindly agreed to donate two copies of their Drug Round Game, in which teams take turns answering medication safety questions and calculating drug doses to facilitate their progress along a modified snakes and ladders board. We all were hoping to explore whether the game would be useful in a 2-hour drug calculation training session led by the lead pharmacist in the Beira-Ipswich partnership. This had previously taken the format of a lecture and whole group discussion.
We packed the games in our suitcases, flew them to Beira (which was not at all like the plot of the movie ‘Snakes on the Plane’, thankfully!) and got to work in piloting with some helpful junior nurses and pharmacists. We were relieved that the board game did seem to translate culturally and linguistically (‘Cobras and Escadas’ in Portuguese) and the players’ enthusiastic participation, accompanied by much laughter and vociferous debate was noted by Beira’s pharmacist and nursing director who observed discretely.
The pharmacist trainer decided to incorporate the educational game as the main teaching tool of the drug calculation training, and helped by pharmacist colleagues, introduced it to 36 nurses attending the training sessions over two days. Once they got to grips with it, the nurses were enthusiastic and eager, laughing, contributing to group solutions together, asking for advice from pharmacists and using the calculators we provided to accurately calculate doses. This was a success in itself: one of the patient safety aims of the Ipswich-Beira partnership is to encourage health professional communication and multi-disciplinary team working. From an evaluation perspective, it was also helpful that we could gauge the nurses’ approximate drug calculation abilities through a simple count of correct: incorrect answers and collect anonymous pre-post self-efficacy ratings for calculating doses correctly. This had not been possible previously for fear that staff would worry about visibly being tested and any consequences for their mistakes.
Qualitative feedback was overwhelmingly positive, comments included: ‘the training game was really good, because it opened the mind more and so we will remember it always’ and ‘the drug calculation training was wonderful’. There were signs that nurses intended to make changes to their practice: ‘I will explain to my colleagues how to calculate IV drip rate and how to administer. I will use the calculator when necessary to calculate.’ Encouragingly, the pharmacist felt able to make the game his own, changing it to suit local needs and even had ideas about adapting it for use in teaching other patient safety skills. On the final day we spotted him heading off to the wards with the game to play with other nurses, suggesting it would be put to good use.
From a behaviour change perspective, introducing an educational game meant greater use of the behaviour change techniques ‘behavioural practice and rehearsal’ and ‘feedback on behaviour’ and a more active and fun mode of delivery. We would hope ultimately that this could lead to greater implementation of the drug calculation skills practiced by our nurses in Beira Central Hospital. All in all, we were pleased that in trying this version of snakes and ladders, we appeared not to have introduced yet another deadly snake to Mozambique, but a fun health professional training idea that could be used in Beira Central Hospital and other projects in future.