On the Rural Roads with Pediatric Simulation Training Karen M. Mathias, MSN, RN, APRN-BC Director Barbara J. Peterson, RN Simulation Specialist
Objectives Identify key patient safety issues that make simulation in healthcare an important topic. Describe why simulation is an effective teaching method and how it can enhance pediatric and neonatal resuscitation training. Work through the process of identifying an organization s specific training needs to create a customized simulation program that can improve team performance in response to pediatric and neonatal critical events.
Delivering Next Generation Care
Children s Simulation Center Advancing patient safety through simulation Improving the quality of pediatric health care Partnering with families & the community
Partner with community hospitals Sharing knowledge and expertise Practice readiness
Background IOM Between 44,000 & 98,000 Americans die each year due to preventable medical errors (Kohn, Corrigan, & Donaldson, 1999) Nearly 4500 children in the United States die annually due to preventable medical errors (Miller, M. R., & Zhan, C., 2004) An estimated 65% of medical errors may be attributed to failures in team communications and human factors (JCAHO, 2005)
Background 27% of ED patients are children cared for in hospitals that lack the expertise or the equipment needed for those that are critically ill (IOM Committee on Quality of Health Care in America, 2001) Medical errors in children involve: failure to rescue, medication miscalculation, lack of familiarity with stabilization procedures, developmental variations, difficulty of history-taking, & teamwork and communications breakdowns (Committee on Pediatric Emergency Medicine, 2007) Pediatric resuscitation is a low-volume, high-risk event 1 resuscitation case for every 815 ED patient visits (ED database, 2005)
Team Training Aviation Crew Resource Management Health Care Crisis Resource Management
Health Care Healthcare crisis are much more frequent Rapid and correct decisions are expected Despite frequency of crisis we don t train PALS/NRP every 2 years For many pediatric areas how long before we get a really sick kid?
What is Simulation Training? Clinical simulation is an event or situation made to resemble clinical practice as closely as possible. (Seropian, 2003)
High Fidelity Patient Simulator SimBaby
Why is Simulation Effective? Adult learning principles utilized Train in multidisciplinary teams Realistic environment with same challenges and stressors Reflective learning
The Cost of Simulation Expensive modality Charging based on the average costs associated with the day of travel Student to faculty ratio is low this also adds cost to the organization sending staff for training 2009 Full day training $2300 + mileage Includes up to two ½ day sessions for up to 8 staff members per session
Objectives Recognize the unique healthcare needs and challenges of children and what we can collectively do for the pediatric patients and families we serve. Work together with colleagues to improve team response. Identify cognitive, technical, and behavioral skills necessary to execute appropriate responses to critical medical events. Practice these skills in a realistic simulated environment that simulates the dynamic nature of the clinical setting in which each team practices. (Emergency department, NICU, delivery room, level II nursery, PICU, or pediatric unit.)
Course Planning Initial intake Provide planning guide Scenario grid Staff communications Logistics to consider Determine courses Set clinical planning meeting
Logistics and Challenges Logistics Who are the teams that will train? Scheduling of teams of up to 8 participants Determine the threehour timeframes Bus location Challenges & considerations Staffing and scheduling Realistic teams doctors, advanced practice nurses, nurses, respiratory care, pharmacy, EMS Partnering with other community hospitals
Customizing the Curriculum Clinical Planning Meeting Who is the target audience? At the end of the session, what do you want the participants to be able to do? Is there any equipment you want people to be able to use? What systems do you use for supplies or medications? Are there performance improvement projects or policy changes to infuse/test in the scenarios?
Scenario Planning Scenario PALS guidelines Technical Skills Behavioral/Communication Skills Bronchiolitis/RSV Respiratory Distress - Lower airway disease -Assessment of infant in respiratory distress -Early recognition of infant s deteriorating condition O2 delivery Suctioning prn Nebulization IV Rapid sequence drugs Intubation/assist with intubation Call for help early Communicate using SBAR re: infant s worsening condition Work as a team when child progresses to respiratory failure. Parent present (Y/N) Shock Dehydration/ Hypovolemia Respiratory Failure Early Recognition of Shock Fluid resuscitation algorithm O2/monitors IV/IO access Fluid resuscitation Blood glucose Add pressors Call for help SBAR to physician re: changing status of patient Talk/think out loud Look at roles of team members
Customized Curriculum Simulation Scenario: Learning Objectives: At the end of this simulation-based scenario, the learners will be able to: 1. 2. 3. Supplies and Equipment Needed Any new or rarely used equipment to target: Patient Data: History: Initial Vital Signs: Reassessment Vital Signs: Desired Actions: Undesirable Actions:
Simulation Specialist
Suspension of Disbelief
The mobile simulation center comes right to you!
Ground Rules Consent for photography and videography Confidentiality What happens in the simulator stays in the simulator. Professionalism and Collegiality both in the simulator and in the debriefing area. We view each participant as intelligent and professional and expect that integrity would be maintained.
Orientation to the Simulator The Environment The Mannequin
Video taping and controls
The Event
Debriefing
Participant Evaluations Definitely 2007-2008 Simulation Center External Customer Simulation Evaluation n=119 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 Not at all 5.0 Organized course 4.9 4.8 4.8 Supportive instructors Increased confidence Increased knowledge
Course impact Definitely Im proved 2007-2008 Simulation Center External Customers Effect of Simulation Experience on Participant Ability n=119 Some Improvement A little better No effect to apply PALS or NRP guidelines to recognize changing condition to communicate effectively to improve skills to work as a team
Health Care Made Safer Mistakes are puzzles to be learned from, not crimes to be covered up.
Thank You! www.childrensmn.org/simcenter