Download Junior Level: Mock Code

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