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SIMULATION DESIGN & PLANNING TEMPLATE Scenario Name: Mock Code (Tri-level/progressive) 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 per scenario Expected Debrief Time 20-40 minutes per scenario Report and Information Provided To Participants Prior To Simulation Scenario 1 Situation: Learners will be caring for Tony Manero, a 74 year old gentleman in a retirement center, Happy Trails. Mr. Manero moved into the facility in 2012 after he lost his wife of 50 years. Background: Patient has a 10 year history of COPD and had a MI in 2009. He quit smoking in 2004. He is on continuous O2 at 2 LPM via nasal cannula. Pt is independent with ADL except for 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 medication administration. His current medications are: Digoxin, Furosemide, Lisinopril, and aspirin. Mr. Manero’s sister, Annie lives in the facility as well and frequently spends time with Tony in his room. Assessment: For the last day or two he has been complaining of increased fatigue and shortness of breath and seems increasingly forgetful. Vital signs assessment has been increased to every 8 hours. His baseline vitals are: BP 110’s/high 70’s, Pulse 80-90, RR 15-18, Temp 37.0, SPO2 95%. Recommendation: Assess patient closely today and notify charge nurse of any changes in condition. Give daily care including medications. increasing instability and initiate new orders. Patient Information Patient Name: Age:74 Tony Manero Gender: Male Birth date:, 5/30/1939 Weight: 84kg Height: 5’10” ID band MR #00001234 Acct. # 1198765432 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 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. 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 Assignment Of Roles Primary Nurse Secondary Nurse Clinical Instructor (Faculty) Family Member #1 Observer(s) Important Information Related To Potential Roles: First Scenario: For Junior Nursing Students: Primary Nurse, Secondary Nurse, (Optional: Clinical Instructor, Charge Nurse, EMT, Family member: Sister Annie.) SIM Setup Moulage Mannequin IV site : Manikin should be pale, cyanotic and diaphoretic with lower extremity edema. 3G or Task trainer arm Site: Right Antecubital Gauge 18G for scenario #2. Fidelity : Preferably high fidelity manikin or mid-fidelity/standard patient hybrid. 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 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 B Physician Orders : See Attachment A (3 pages) Scenario 1: (Assisted living facility) Vitals signs every 8 hours and prn condition change. Regular diet. Aspirin enteric coated 325 mg one tab PO every day Furosemide 80 mg PO every 12 hours Lisinopril 20 mg PO every 12 hours Digoxin 0.25 mg PO every 24 hours; hold and notify healthcare provider for HR less than 60 After SBAR by learner: Call 911 for transfer to ER. Scenario Progression Outline 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 Stage 1 Initial Amount Time in Initial a15 mins Verbalization (Pt/Manikin Cues) Scenario #1 Baseline Vital Signs T 37.6 PR 120 R 32 BP 100/60 SPO2 88% Cardiac Rhythm: Sinus Tachycardia Breath Sounds: Crackles/Diminished bases Heart Sounds: S1 and S2 Abdominal Sounds: WNL Other Symptoms: Eyes open, blinking fast Cyanotic Accessory muscle use Trending: SPO2 decreasing over time, more quickly if O2 is not given, RR and HR increasing. Pt is slighty confused and anxious. Pt is leaning far forward in chair stating “ I cannot breathe. I’m dizzy”. Oxygen canula is dangling around neck. When emergency team arrives, pt resists leaving facility stating “I’ll be fine. Please don’t make a fuss over me.” Expected Interventions Assess patient vital signs, pain level, LOC, breath sounds, etc. Apply Oxygen at 2L/min. Reassure pt. Help into bed with HOB raised. Retake VS Check POLST. Notify Clinical Instructor and/or charge nurse of patient’s condition. Inquire if oxygen can be increased. Prepare pt for transfer to ER. Learner will calm patient and sister, educate about current condition and plan. Alternate or Incorrect Treatment Choice That Will Affect Outcome Confederate Actions/Additional Role Player Cues If patient is not correctly assessed, managed and help is not summoned, pt will quickly drop saturation and become more confused and very anxious, stating “I’m scared. Something is not right—I really cannot breathe!” Sister Annie will be in room stating “He doesn’t look so good. Tony are you OK. What’s happening to you?” Annie becomes anxious and somewhat combative when decision is made to transfer to ER. . 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 ________________________ Participant Check List 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 (return to Instructor at the end of class) 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). 7 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). 8