Recognising the Deteriorating Adult Simulation Scenario 3 Chronic Obstructive Pulmonary Disease Course lead Colette Laws-Chapman Faculty Course / Curriculum Recognising the Deteriorating Adult Target Delegates Scenario name Scenario 2 Group Exacerbation of Chronic Size Obstructive Pulmonary Disease (COPD) Nursing Assistants in Adult Care Settings 12 Patients Name: Patients Age: Major Problem Learning Goal Narrative Description Tony Thomas 79 year old male Medical Suggested NTS / Technical Exacerbation of COPD Medical / Clinical Effective team communication. Utilise ABCDE assessment How to communicate within Observations/ re-assessment multidisciplinary team. Patient At Risk (PAR) score Leadership (& delegation) with appropriate Care and Compassion documentation. Calling for help Calling for help early. Use of SBAR. Infection Control & Dignity 79 year old male brought in by ambulance to A&E resuscitation department with worsening COPD. Admitted to the ward after initial stabilisation. Patient develops severe Shortness of Breath (SOB), worsening respiratory rate, only speaking occasional words Staffing Case Briefing Past medical history: COPD previous episode of ventilation on intensive care for 4 weeks, 2 x myocardial infarctions, coronary artery disease (CAD), Peptic ulcer disease. Drug history: Home oxygen-2 litres (Patient normally saturates 91-92%), Home nebulisers- Ipratroprium Bromide & Sabutamol, Uniphylline, Frusemide, Nifedipine, GTN spray, Omeprazole. Faculty Control Room: 1 x technician 1 x patient voice 1 x debriefer Faculty Role Players: 1 x Nursing assistant (plant) 1 x senior nurse or doctor (help) To All Candidates Tony is a 79 year old male with COPD. He has been ok on the ward all morning Recognising the Deteriorating Adult-Scenario 3- Exacerbation of COPD page 1 of 5 Candidates 2 x Nursing Assistants (Can enter one at a time) To Role Players Newly appointed Nursing assistant.
Manikin preparation Room set up Simulator operation Props needed Notes to faculty with 2 litres via nasal cannula. He normally manages well with his COPD. Your colleague has gone on break and has asked you to do his 4 hourly observations which are due now. You become very concerned about Tony as he appears to be getting tired. You can help if told exactly what to do. Male patient sat up in bed, Dressed with older gentlemen s wig (if available) in gown or pyjamas Attached to Oxygen via nasal cannula at 2 L/min Not attached to any monitoring, No intravenous (IV) access Wearing name band. As per routine ward. Newspaper. Patient is mildly cyanosed and his chest is wheezy all over. Patient quickly deteriorates with increasing respiratory rate, heart rate and dropping oxygen saturations. He will respond to delivery of high flow oxygen and any appropriate intervention e.g. nebulisers. He becomes more tired and less responsive as he deteriorates, with slowing of respiratory rate if no intervention given. Patient notes and charts. Standard ward equipment, drugs and consumables. Resuscitation trolley. Nebuliser box. Newspaper. The underlying cause is an acute exacerbation of COPD. The purpose of the scenario is to reinforce ABCDE assessment and early recognition of a deteriorating adult patient. Delegates are expected to use an early warning score system and initiate necessary interventions such as emergency oxygen therapy. They are expected to call for help early utilising a handover tool such as SBAR/SPAR. The scenario will end with arrival of help, either a senior nurse or doctor and a structured handover. Recognising the Deteriorating Adult-Scenario 3- Exacerbation of COPD page 2 of 5
Observations: Initial HR 110 1 O2 /sats 84% 3 RR 25 2 Urine output GCS 15 AVPU A No recorded fluid balance chart but has stated they passed urine in that morninggood amount. Total Par Score 6 0 BM = 5.8 If O2 increased above 2 L/min sats improve to 86% Cap refill 4 HR 140 3 O2 sats 80% 3 + 1 (High flow o2) RR 45 3 UOP No recorded fluid 0 balance chart but has stated they passed urine in that morninggood amount GCS 14 AVPU V 1 Total Par Score 11 Pt unresponsive /BVM ventilate HR 140 3 O2 sats 78% (BVM 90%) 3 + 1 (2 +1 BVM) RR 6 to BVM 2 UOP Has no record FBC Recognising the Deteriorating Adult-Scenario 3- Exacerbation of COPD page 3 of 5 Then patient tires quickly and needs BMV ventilation
not started AVPU U 3 Total Par Score 12 Patient Role You are a 79 year old man who has become increasingly SOB on the ward talking in single words only. If asked, you have not passed urine today but did yesterday. After a period of increased breathlessness, you become tired, respiration rate drops and you are less responsive/ unresponsive. You prefer to be called Tony and hope that the doctors can sort you out quickly as you want to get back to your racing pigeons you have been a racer for many years and love to bet on them. Past medical history: COPD previous episode of ventilation on intensive care for 4 weeks, 2 x myocardial infarctions, coronary artery disease (CAD), Peptic ulcer disease. Drug history: Home oxygen-2 litres (Patient normally saturates 91-92%), Home nebulisers- Ipratroprium Bromide & Sabutamol, Uniphylline, Frusemide, Nifedipine, GTN spray, Omeprazole. NA Role (Plant) Scenario 79 year old man is on a general ward. He is known to have COPD and has home oxygen and nebs. The NA s have been caring for him, but over the course of the morning he has become more SOB, is tiring and is now only able to speak occasional words. Past medical history: COPD previous episode of ventilation on intensive care for 4 weeks, 2 x myocardial infarctions, coronary artery disease (CAD), Peptic ulcer disease. Drug history: Home oxygen-2 litres (Patient normally saturates 91-92%), Home nebulisers- Ipratroprium Bromide & Sabutamol, Uniphylline, Frusemide, Nifedipine, GTN spray, Omeprazole. Recognising the Deteriorating Adult-Scenario 3- Exacerbation of COPD page 4 of 5
Instructions You are newly appointed NA who has had very little training yet as you are on induction to your first caring post you are not able to find anything in your department. You are able to take instructions for tasks appropriate to your level but you have yet been assessed as competent. You notice he is tiring and so have urgently called over the other nursing assistants as your peers because you are nervous to approach the nurses and doctors Ward sister/ charge nurse or ANP/SNP Scenario Tony Thomas is a 79 year old man on a general ward. He is known to have COPD and has home oxygen and nebs. The NA s have been caring for him, but over the course of the morning he has become more SOB, is tiring and is now only able to speak occasional words. Instructions Phone conversation or on the ward-you have been asked to review Tony Thomas as you have heard or been told he is deteriorating. You can prompt an SBAR handover and ABCDE assessment with a full set of observations and PAR score. You may want to say you have lots of sick patients and when are you needed for the review. Results of Investigations Bloods Gases Imaging Other Recognising the Deteriorating Adult-Scenario 3- Exacerbation of COPD page 5 of 5