Download Resident Level: Mock Code

SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Name: Mock Code Resident RN
Program/Curriculum Specific Objectives. This scenario is intended to:
 Offer opportunity to practice emergency response
 Improve learner confidence
 Improve team work and communication
 Improve patient safety
Measurable Objectives
1. Learner will demonstrate assessment of the cardiovascular and pulmonary system
2. Learner will recognize abnormal assessment findings.
3. Learner will initiate appropriate emergency interventions.
4. Learner will demonstrate effective CPR/ACLS as appropriate.
5. Learner will communicate effectively.
Authors: Marie Arnone, Swedish Medical Center. Janet McGuigan, Seattle
University
Date Submitted June 2013
Yes. At facilitator’s discretion,
lecture could include concepts behind the pathophysiology and treatment of: COPD, pneumonia, and heart
failure as well as facility specific code response protocols.
Will There Be Any Pre-Simulation Lecture?
Duration: 20-30 minutes.
Expected Scenario Time 10-15 minutes Expected Debrief Time
20-40 minutes
Report and Information Provided To Participants Prior To Simulation
Patient Information
Patient Name:
Age:74
Tony Manero
Gender:
Male
Birth date:, 5/30/1939
Weight: 84kg
Height: 5’10”
Hx. Present Illness: Mr. Manero is a 74 year old gentleman residing in an assisted living home. He
has been a resident since 2012, a few weeks after losing his wife of 50 years. He has a history of
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
1
SIMULATION DESIGN & PLANNING TEMPLATE
COPD for 10+ years and a MI in 2009. He is on continuous O2 at 2 LPM via nasal cannula. Pt is
independent with ADL except for medication administration. For the last day or two he has been
complaining of increased fatigue and shortness of breath.
Social History: Patient is a retired painter who was widowed in 2012. He has two grown sons both of
whom live in New York City. He has a sister, Annie who lives in the assisted living home as well.
Religion: N/A
Support System: Sister Annie. Two sons Vincent and Paul live out of State.
Allergies: Penicillin
Immunizations:
Up-to Date
Attending Physician: Dr. Wright
Past medical history: Pt is a 74 year old gentleman with past history of COPD diagnosed in 2002, MI
in 2009 and heart failure in 2009. Current meds are Digoxin, Furosemide, Lisinopril, aspirin.
Moulage: Male manikin. Apply thin layer of protective gel (Vaseline) on lips and face and apply
makeup to have pt appear pale and cyanotic (blue shadow to lips, eyelids, fingers and toes if
cyanosis is not available on manikin). 2+ pitting edema in lower extremities.
Assignment Of Roles
Primary Nurse
Secondary Nurse
Clinical Instructor (Faculty)
Family
Member #1
Observer(s)
Code Team List Members:
Respiratory Therapy
Physician/ Advanced Practice Nurse
Important Information Related To Potential Roles:
Third State: For Resident Nurses or Senior Students: Primary Nurse, Secondary Nurse, Charge nurse,
Code Team Leader (Optional: Code Team Members).
SIM Setup
Moulage
Manikin should be pale, cyanotic and diaphoretic with lower extremity edema.
Mannequin
IV site :
3G or Task trainer arm
Site: Right Antecubital Gauge 18G for scenario #2.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
2
SIMULATION DESIGN & PLANNING TEMPLATE
Fidelity : Preferably high fidelity manikin or mid-fidelity/standard patient hybrid.
Setting/Environment
Med-Surg
Long Term Care/Assisted Living
Props:
Equipment attached to manikin:
Primary IV Fluid running at 75 ml/hr
O2 2L/min
Monitor attached/ Type
ID band
Equipment available in room:
Crash cart c airway devices and emergency meds
Urinal/Bedpan
Fluids
Incentive Spirometer
IV start kit
IV tubing
IVPB tubing
IV pump
O2 delivery device
Suction
Defibrillator/Pacer
Medications and Fluids:
Oral Meds
IV Fluids
IVPB
IV Push
IM/Subcut/Intradermal
Diagnostics Available:
Labs Values
12 lead EKG
Documentation Forms:
Admit Orders
Physician Orders
MAR
Graphic Record
Shift Assessment
Code Record
Transfer Orders
Recommended Mode for Simulation
Manual/Programmed Hybrid
Manikin to be used High Fidelity
Significant Lab Values : See Attachment BPhysician
Orders : See Attachment A (3 pages)
State 3:
CPR continuous at 30/2
Defibrillation per manufacturer recommendation on defibrillator 200,
300,360
Epinephrine 1 mg diluted to 1:10,000 IV push
Amiodarone 300 mg IV push
NS 250 ml over 10 minutes
Amiodarone IV infusion 1mg/min (360 mg IV over 6 hours)
Transfer to ICU
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
3
SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Progression Outline
Initial Amount
Time in Initial a15 mins
Scenario #3
Code Team arrives:
Baseline Vital Signs
T 38.0 P 0 R 0
BP poor signal
SPO2 nondetectable
Cardiac Rhythm:
Coarse Ventricular
fibrillation
Breath Sounds:
Absent
Heart Sounds: none
Abdominal Sounds:
Absent
Other Symptoms:
Pt is non-responsive
and with gasping
respirations.
Verbalization
(Pt/Manikin
Cues)
Prompt:
Shock advised.
Stand Clear.
Charging
defibrillator to
manufacturer
recommendation.
Pt continues to be
non-responsive
After 3-4 cycles of
CPR and
defibrillation and
medication
administration, pt
returns to
spontaneous
breathing or is
intubated and
transferred to ICU to
end scenario.
Prompt:
Shock advised.
Stand Clear.
Charging
defibrillator to
manufacturer
recommendation.
Expected
Interventions
Facilitator should assume
the role of the code leader
and provide orders. One
team member should be
assigned to stay with
“Annie” and keep informed
of situation.
Learner to assess patient and
situation.
CPR in progress:
30compressions/2
ventilations.
Connect AED/defib device
←and follow prompts:
(Operator states “stand
clear” and looks to assure
that everyone is clear of the
patient. Delivers shock)
Code Leader: “Resume
CPR.”
After 2 minutes (5 cycles) of
CPR-reassess and follow
defibrillator /facilitator
prompts to shock again:
(Operator states “stand
clear” and looks to assure
that everyone is clear of the
patient. Delivers shock)
Code Leader: “Resume
CPR”.
Assure IV access and
consider intubation
Code leader orders
Epinephrine 1 mg IV push
(Administers IV epinephrine 1
Alternate or Incorrect
Treatment Choice
That Will Affect
Outcome
Confederate
Actions/Additional
Role Player Cues
Sister is in room and
quietly crying.
If CPR is not correctly
done, pt could expire
at facilitator’s
discretion and code
could be repeated
successfully.
All learners should
rotate through to
perform CPR
mg/10ml during the 2 minutes
of CPR.)
After 2 minutes of CPR
reassess rhythm and follow
defibrillator/facilitator
prompt to shock rhythm.
(Operator states “stand clear”
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
4
SIMULATION DESIGN & PLANNING TEMPLATE
and looks to assure that
everyone is clear of the patient.
Delivers shock)
Code leader:“Resume CPR”
and orders Amiodarone 300
mg IV push
(Prepares and administers
amiodarone during the 2
minutes of CPR)
After 2 minutes of CPR
reassess rhythm and follow
defibrillator / facilitator
prompt to shock
(Operator states “stand clear”
and looks to assure that
everyone is clear of the patient.
Delivers shock)
Rhythm changes to
sinus bradycardia
and then to sinus
rhythm Patient
begins to respond
ETCO2 increased to
35, patient beginning
to spontaneously
breathe
T 38.7
P 60
R 16
BP 100/60.
Rhythm changes to sinus
bradycardia.
Code leader: Stop CPR
Orders 250 ml of NS and
amiodarone drip at 1mg/min
Prepare to transfer to
ICU
Annie is extremely
grateful to team.
“Thank you so much
for helping my little
brother.”
(Prepare and hang
amiodarone drip to be
administered at 1mg/min.)
Gives handoff report to ICU
team.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
5
SIMULATION DESIGN & PLANNING TEMPLATE
Instructor Check List
(return to CHESC assistant at the end of class)
Pre-Scenario Check List
1.
2.
3.
4.
5.
6.
7.
8.
Equipment is staged as requested.
The learner has been oriented to the simulator.
The learner understands the guidelines/expectations for the
scenario.
Participants understand their assigned roles.
The time frame Expectations for simulation met: Yes No.
The time frame Expectations for debrief met:
Yes
No.
Audio/Visual Consent signed and turned into CHESC sheet.
Attendance sheet completed and given to CHESC staff.
Post Scenario
If you could change anything next time, what would it be?
Comments:
________________________________________________________
________________________________________________________
________________________________________________________
CHESC Assistant Name:
Did the person provide excellent support for the scenario?
Yes
No Comment
Instructor signature ________________________________
Date
________________________
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
6
SIMULATION DESIGN & PLANNING TEMPLATE
Participant Check List
(return to Instructor at the end of class)
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
7
SIMULATION DESIGN & PLANNING TEMPLATE
Pre-Scenario Check List
1.
2.
3.
4.
5.
I have been oriented to the simulator.
I understand the guidelines/expectations for the scenario.
I understand the assigned role.
My questions about the simulation have been answered.
I have all necessary equipment for the simulation.
Post Scenario
If you could change anything next time, what would it be?
Comments:
______________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Participant Signature ____________________________________
Date
________________________
Simulation Post-Assessment Methods
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
8
SIMULATION DESIGN & PLANNING TEMPLATE
Checklist
Tests
Evaluations
Turning Point
Jeopardy
Other
Literature References
Joseph,S.,. Cedars, A.M. , Geltman, E., Douglas L. Mann, D.L. (2009)Acute Decompensated Heart Failure: Contemporary Medical Management.
Tex Heart Inst J. 2009; 36(6): 510–520.
Johnson,G. Before the Code Team Arrives: Insitu Simulation for Non-Code Team Staff. Clinical Simulation in Nursing. October 2012 (Vol. 8,
Issue 8, Page e401, DOI: 0.1016/j.ecns.2012.07.046)
Varughese, S. (2007) Management of Acute Decompensated Heart Failure. Critical Care Nursing Quarterly. June 2007. Volume 30. Number
2. Pp94-103.
CAE Heathcare. Acute Heart Failure Exacerbation. Program for Nursing Curriculum Integration. 2012.
Debriefing Guidelines
(Remember to identify important concepts or curricular threads that are specific to your
program)
1. Leave the simulation room and go to a conference room, if possible. It allows for deescalation of emotions.
2. Solicit and validate emotions briefly. Validate simisms (the simulation isn’t 100% accurate
due to different equipment, personnel etc)
3. What went WELL in this simulation?
4. What DID NOT go well in this simulation?
5. If you could do it again, what would you do differently?
6. Summarize:
“What I hear you saying is . . .”
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
9