University of South Dakota Vermillion, South Dakota Department of Nursing. Simulation Scenario Safety: Patient Safety. Overview

Transcription

1 Simulation Scenario Safety: Patient Safety Overview Title: Patient Safety Concept: Safety Target Course: First Year Nursing Students To cite this reference Dreke, C. (2012). Simulation scenario; Safety: Patient safety. Unpublished manuscript., at Vermillion. Time Allotment (each simulation is designed to be ran in a two hour block of time which equals four clinical hours): Prep: Campus specific (see preparation requirements) Prebriefing: Campus specific (first year students should be longer than second year students according to evidence-based practice [EBP] standards) Simulation: minutes (no longer than 30 minutes) Debriefing: Campus specific (first year students shorter than second year students according to EBP standards) If the simulation episode runs less than two hours faculty should consider running the simulation again, creating concept maps, creating teaching plans, performing webquests, or implementing other activities that would be beneficial to the students' learning. DocuCare Information: Dorothy Bloom is a 70-year-old patient who had bilateral knee replacements. She needs assistance with transfer. She has a history of MRSA in an old wound. Students are to do an assessment, give medications and reasons why the patient takes these medications as well as use PPE appropriately. The room is filled with little errors that can affect patient safety.

2 Safety: Patient Safety 2 AACN Essentials: IX Curriculum Alignment Population: Elderly Caucasian female Concepts Exemplar Safety (Interrelated: Mobility) Patient Safety Objectives and Outcomes Area Scenario Objectives Course Outcomes Knowledge Will identify actual or potential patient safety 5.1 issues. Skills Provide safe patient transfer. 1.1, 1.2, 6.1 Attitudes Adhere to safe medication administration practices. Evaluate nursing care provided during the simulation and identify safety issues that did occur or could have potentially occurred. 3.1 Student Preparation Prerequisite assignment (the following information should be sent to the students prior to the scheduled simulation). Students are expected to bring their laptop, drug book, and primary text. Complete the (Patient Safety Student Prep) document.

3 Safety: Patient Safety 3 Simulation Setup Manikin Settings: Initial Vital Signs (If using manikin): Pulse: 82 Blood pressure: 149/87 Pulse ox: 92% Respiratory rate: 22 Temperature: 99.0 Cardiac rhythm: Sinus rhythm Lung sounds: Clear Bowel sounds: Normal Other: Change in Vital Signs How many minutes until change? Pulse: Blood pressure: Pulse ox: Respiratory rate: Temperature: Cardiac rhythm: Lung sounds: Same as above Equipment List ID and allergy bands IV Pump/tubing/NS B/P machine Dressing change materials: 4 X 4 gauze & tape or Tegaderm stethoscope Pulse oximetry Equipment attached to manikin or live person: IV tubing/pump on right side 100 ml/hr ID band Allergy band Foley catheter Personal Protective Equipment Personal Protective Equipment sign (contact isolation MRSA) Equipment List (continued) Secondary tubing for IV antibiotic Little Errors in room: 1. Foley attached to patient but foley bag laying on the floor instead of hanging on bed 2. Syringe lying in the patient s bed 3. IV pump set at 150 cc/hr instead of 100 cc/hr 4. Old dressings from yesterday crumpled on the floor 5. Family member not wearing PPE 6. If patient doesn t take medications with nurse in the room-potential for error 7. Call light not near the patient 8. Medication bottles with pills in them from patient s house 9. Linen/towels laying on the floor 10. Pack of cigarettes near the patient Scenario Setting: Setting: Inpatient Time of day of scenario: 0800 Patient Condition Clothing: Patient gown Props: Moulage: Wig, necklace patient Chair Gait belt Slippers/non-skid Call light Water pitcher Kleenex Breakfast tray Bilateral knee dressings Bilateral knee incisions

4 Safety: Patient Safety 4 Roles for Students Primary nurse Secondary nurse Observer Other Family member Recording Nurse Medication Nurse Attending Physician: Dr. Winters Student Names (Faculty) Documents MAR Physician Orders BMP, CBC Medication Dosage Route Metformin 500 mg PO HCTZ 25 mg PO Multivitamin Tablet PO Calcium with 500 mg PO Vitamin D Boniva (Not needed for scenario) 150mg PO Concentration Package Vancomycin 1 gm (200 ml bag) IV 100cc/hr IV

5 Safety: Patient Safety 5 Patient Demographics Last Name: Bloom Patient Background First Name: Dorothy Gender: Female Age: 70 DOB: 5/25/XX Ht: 5 3 Wt: 53 kg Ethnicity: Caucasian Religion: Catholic Language: English English Proficiency: Yes Other: Does not believe in flu or pneumonia vaccinations; all others up to date. History of present illness: The patient had elective bilateral knee replacements 2 days ago. Primary Medical Diagnosis: Bilateral Knee Replacement Central nervous system Cardiovascular Pulmonary Renal/Hepatic Gastrointestinal Musculoskeletal Integument Developmental history Psychological history Social history Diabetes x 4 years History of MRSA in an old wound Surgical history Hysterectomy (age 50) Appendectomy (age 25) Left mastectomy (age 60) Current smoker x 50 years. Widowed, retired school teacher, enjoys crocheting and playing bridge. Medication allergies PCN Reaction: Food/other allergies Reaction: Home medications Metformin 500 mg PO every day HCTZ 25 mg PO daily Multivitamin one tablet daily Calcium with Vitamin D 500 mg PO BID Boniva 150 mg once a month.

6 Safety: Patient Safety 6 Prebriefing Give students the opportunity to discuss their feelings and fears (can use the round table approach) and then have discussion. 1. Discuss the student prep (worksheet, journal articles, readings, etc.) a. In discussion of the worksheet for prep, could discuss what does each of the labs/assessment mean for the nurse or what should the nurse do with the data. b. Can discuss each of the questions. 2. Discuss topics related to lecture of safety. 3. Discuss patient safety. 4. What are some things nurses can do to impact patient safety? 5. How do patient safety and sentinel events correlate? 6. How can hand-off reporting affect patient safety? 7. Describe how you think the patient may be presented to you during this simulation. 8. Explain how you might care for this patient. 9. Any questions? The above items are listed to assist faculty in leading a pre-briefing discussion with students. Feel free to use some or all of the items depending on the needs of the student group.

7 Safety: Patient Safety 7 Change of shift report to students (if applicable): Scenario Dorothy Bloom is a 70-year-old female patient of Dr. Winters. She had bilateral knee replacements 2 days ago and is on IV antibiotics. She has dressings to her bilateral knees the dressings were changed yesterday. She gets up with assist of 1-2. Her history includes: smoker, hysterectomy, left mastectomy, appendectomy, and a history of MRSA in an old wound. She is alert and oriented x 3. Timing Patient actions live faculty Expected interventions May use the following cues: 5-7 Minutes Faculty or Manikin: Can be somewhat demanding. Wants to get up but call light not near the patient. Wants to sit in the chair for breakfast. I need to get up that s all they tell me around her is get up and move. Do you really need to wear all of that stuff every time you come in the room? It takes you so much longer to get in here. Nurses need to use PPE before entering the room. -Can educate family member on importance of wearing PPE while in the hospital. Performs hand hygiene, completes assessment, vital signs, pain assessment, assess knee dressings (could change dressing too). Uses proper technique for patient transfer after knee surgery. Family member will not be wearing PPE. Family member can ask questions regarding why they would need to wear PPE here when they don t wear it at her house. Should not do BP on left arm r/t mastectomy. 5-7 Minutes The doctor tells me I need to take my diabetes pill with meals. (Can say you will wait to take the other meds when you are done eating or as you eat; my family member will make sure I take them ) Nurse should administer PO medications and explain what each one is for. Administer IV antibiotic. Nurses should tell you to take your meds while they are in the room. Family member can ask questions related to medications and IV antibiotic.

8 Safety: Patient Safety Minutes How long do I have to sit up in this chair? My knees already hurt. Can administer pain medication if not done earlier. The room has many little errors in it. See if the students notice or correct any of the errors in a short amount of time. Little errors list is found in Simulation Scenario on page three.

9 Safety: Patient Safety 9 Debriefing Start out by asking students about their feelings/thoughts related to the experience. It is alright to let the students lead the discussion at first. Utilize the questions below at your discretion. Debriefing / Guided Reflection Questions for this Simulation: 1. How did you feel throughout the simulation experience? a. Emotions (are students angry, happy, confused, etc.) 2. Could discuss with students their thinking in how they knew to do certain things or why they did certain things (i.e. correct technique to transfer the patient with bilateral knee replacements, information related to PPE). This allows students to share with other students out-loud how they are critically thinking and piecing together information. 3. Discuss things on student s minds. 4. Describe the objectives you were able to achieve? 5. Which objectives were not achieved? Why? 6. Did you have the knowledge, skills, and attitude to meet the objectives? 7. Were you satisfied with your ability to work through the simulation? 8. To Observer: Was there anything the nurses could have done differently in the simulation? 9. If you were able to do this again, how could you have handled the situation differently? 10. What did the group do well? 11. What did the team feel was the primary nursing diagnosis? 12. Discuss with students any little errors they may have noticed around the room. 13. How many little errors did they notice? 14. Can take students back into the room to see how many issues they see now after the scenario.

10 Safety: Patient Safety Discuss how as the nurse assesses a patient, the nurse is also assessing the patient s environment. a. Examples: i. Noticing for safety issues in the room ii. Assessment of the patient overall: color of urine in a foley bag, wounds, etc. iii. Noting how well a patient moves and if they are able to go home after discharge b. This is also applicable in a home environment with a home health nurse. i. Could discuss things a nurse would assess in a home visit. 16. Is there anything else you would like to discuss? The above items are listed to assist faculty in leading a debriefing discussion with students. Feel free to use some or all of the items depending on the needs of the student group.

11 Safety: Patient Safety 11 Supporting Documents Forms Patient Chart Information/Forms Patient Safety Charts Scripts/Roles Patient Safety Script Recommendations For Online Use This simulation could be performed in the mobile simulation unit and streamed to distance students. Students at a distance could participate in the pre-briefing and debriefing sessions using webinar.