Transcript Creating your Pediatric Mock Code Program

CREATE YOUR PEDIATRIC
MOCK CODE PROGRAM
Illinois Emergency Medical Services for Children is a collaborative program between
the Illinois Department of Public Health and Loyola University Health System
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W ELCOME
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I LLINOIS E MERGENCY
M EDICAL S ERVICES FOR
C HILDREN (EMSC)
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
Illinois EMSC is a collaborative program between the Illinois
Department of Public Health and Loyola University Health
System, aimed at improving pediatric emergency care within
our state.

Since 1994, The Illinois EMSC Advisory Board and several
committees, organizations and individuals within EMS and
pediatric communities have worked to enhance and integrate

Pediatric education

Practice standards

Injury prevention

Data initiatives
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C ONFLICT OF INTEREST
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STATEMENT
This educational activity’s planners
and the presenters have indicated
they have no bias or conflict of
interest.
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CITATION INFORMATION
This program was developed through federal grant
funding. All training materials are considered under
public domain and can be utilized by others in the
conduction of similar educational programs, provided
there is acknowledgement of the source of these
materials.
This slide set, and all related training materials, is in
accordance with current practice at the time that this
program was developed.
Suggested Citation: Create Your Pediatric Mock Code Program, Illinois
Emergency Medical Services for Children, March 2012.
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A GENDA
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1.
Provide the background and history that led to this
program offering
2.
Develop strategies to respond to implementation barriers
3.
Review the steps to pediatric mock code program creation
4.
Incorporate facilitating and debriefing into pediatric mock
codes (Exercise using three videotaped scenarios)
5.
Maintain the gain
6.
Wrap-up/Evaluation
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“Chance favors the
prepared mind.”
Louis Pasteur
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O BJECTIVES
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
Develop strategies to respond to implementation
barriers

Review the steps to pediatric mock code program
creation

Incorporate facilitating and debriefing into
pediatric mock codes
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D EVELOP S TRATEGIES TO RESPOND
TO IMPLEMENTATION BARRIERS
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D EVELOP STRATEGIES TO R ESPOND
TO IMPLEMENTATION BARRIERS
Time
Cost
Unclear how to set up the
program
No one to
coordinate the
program
Lack of
Interest
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D EVELOP STRATEGIES TO R ESPOND
TO IMPLEMENTATION BARRIERS
Time
Cost
Unclear how to set up the
program
No one to
coordinate the
program
Lack of
Interest
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D EVELOP STRATEGIES TO R ESPOND
TO IMPLEMENTATION BARRIERS
Time
Cost
Unclear how to set up the
program
No one to
coordinate the
program
Lack of
Interest
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D EVELOP STRATEGIES TO R ESPOND
TO IMPLEMENTATION BARRIERS
Time
Cost
Unclear how to set up the
program
No one to
coordinate the
program
Lack of
Interest
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D EVELOP STRATEGIES TO R ESPOND
TO IMPLEMENTATION BARRIERS
Time
Cost
Unclear how to set up the
program
No one to
coordinate the
program
Lack of
Interest
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D EVELOP STRATEGIES TO R ESPOND
TO IMPLEMENTATION BARRIERS
Time
Cost
Unclear how to set up the
program
No one to
coordinate the
program
Lack of
Interest
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R EVIEW THE STEPS TO PEDIATRIC
MOCK CODE PROGRAM CREATION
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PEDIATRIC MOCK CODE PROGRAM VS .
PERFORMING A SINGLE MOCK CODE
Program

Needs assessment
information is applicable to
future events

Standard format builds
predictability
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Decrease staff fears
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Practice over time builds
competence and
knowledge retention
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Single mock code
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Same amount of pre-code
preparation needed
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Effect of a one-time code is
inadequate for knowledge
retention

No opportunity to trend
progress over time
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S TEPS TO CREATE A P EDIATRIC M OCK
C ODE P ROGRAM
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• Solicit management support
2
• Recruit team members
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• Conduct a needs assessment
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• Create scenario elements
5 • Complete logistical planning
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• Conduct an initial pilot mock code
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• Hold the pediatric mock code
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• Analyze data and report program results
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S TEP 1: S OLICIT MANAGEMENT
SUPPORT
Management Actions:
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Support offering
pediatric mock codes.

Allow a needs
assessment.

Encourage other staff to
participate.
N EXT STEPS
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Step 3:
Conduct a
needs
assessment
Step 2:
Recruit team
members
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Step 4:
Create the
forms
Hold
Mock
Code
Step 5:
Complete the
logistical
planning
Step 6:
Conduct an
initial pilot
mock code
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S TEP 2: R ECRUIT TEAM MEMBERS
T EAM COMPOSITION AND CHARACTERISTICS
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S TEP 2: R ECRUIT TEAM MEMBERS
D ISCUSS TIME COMMITMENT OPTIONS
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S TEP 3: C ONDUCT A NEEDS
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ASSESSMENT
Survey
elements
Staff fear and
level of
confidence with
pediatric codes
Staff experience
with children
Preferred day
and time for
mock codes
Staff experience
with pediatric
codes
Pediatric
emergency topics
for practice
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S TEP 4: C REATE S CENARIO E LEMENTS
S CENARIO C REATION

Design based on staff needs assessment and
institutional preferences

Create no more than 2-3 goals and
objectives for each scenario
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Keep in mind the skill level and experience
of the learner
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S TEP 4: C REATE S CENARIO E LEMENTS
S AMPLE C HALLENGES
Possible challenges:

Inexperience with defibrillator
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Patient presents with an unstable airway
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S TEP 4: C REATE S CENARIO E LEMENTS
S AMPLE C HALLENGE
Inexperience with defibrillator
?
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S TEP 4: C REATE S CENARIO E LEMENTS
C ORRESPONDING OBJECTIVE
Inexperience with defibrillator
Safely utilize defibrillator
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S TEP 4: C REATE S CENARIO E LEMENTS
S AMPLE C HALLENGE
Patient presents with an unstable airway
?
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S TEP 4: C REATE S CENARIO E LEMENTS
C ORRESPONDING OBJECTIVE
Patient presents with an unstable airway
Select correct size airway devices
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S TEP 4: C REATE S CENARIO E LEMENTS
O BSERVER FORM
Decide on a mock code recording tool

Current unit code review form

Template from Pediatric Mock Code
toolkit
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In-house version

Videotaping
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S TEP 5: C OMPLETE LOGISTICAL
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PLANNING
LOGISTICS CHECKLIST:

Schedule mock code
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Arrange for a facilitator and
an observer (if needed)
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Reserve space

Determine equipment
needed
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Check equipment location
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Confirm replacement process
Photo is property of Illinois EMSC
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S TEP 5: C OMPLETE LOGISTICAL
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PLANNING
LOGISTICS CHECKLIST
(continued):
 Simulated patient choices
 Videotaping
 Repetitive practice
 Evaluation
forms
Photo is property of Illinois EMSC
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S TEP 6: C ONDUCT AN INITIAL PILOT
MOCK CODE
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S TEP 7: H OLD THE PEDIATRIC MOCK
CODE
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S TEP 8: A NALYZE THE DATA AND
REPORT PROGRAM RESULTS
REPORT ELEMENTS:
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Facilitator feedback
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Lessons learned
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Suggestions
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Track progress from baseline
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Celebrate improvements
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Assure safety of the data
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Provide confidentiality
S TEPS TO CREATE A P EDIATRIC
M OCK C ODE P ROGRAM
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1
• Solicit management support
2
• Recruit team members
3
• Conduct a needs assessment
4
• Create scenario elements
5 • Complete logistical planning
6
• Conduct an initial pilot mock code
7
• Hold the pediatric mock code
8
• Analyze the data and report program results
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Break time
10 minutes
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I NCORPORATING FACILITATING AND
DEBRIEFING INTO PEDIATRIC MOCK
CODES
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W HY D EBRIEF ?
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To promote:
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reflection

discussion

learning
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FACILITATORS CREATE A SAFE
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LEARNING ENVIRONMENT
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Emphasize mutual respect
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Encourage team spirit and open expression by
reaffirming common goals
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Seal the environment =
“What happens here stays here!”
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FACILITATOR MESSAGES TO MOCK
CODE PARTICIPANTS
Teamwork
Calm
Respectful
Welcoming
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Encouraging
Participants
Approachable
FACILITATOR ACTIONS
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
Before the Scenario
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Pre-brief elements

Environment and equipment

Introduce the scenario
(Training guide: Using simulation in TeamSTEPPS Training, n.d.)
FACILITATOR ACTIONS
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
( CONTINUED )
During the scenario
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Provide information keeping in mind the scenario goals
and objectives
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Take notes on how it unfolds
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Identify performance gaps
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Identify debriefing points
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What went well

What could be different, missing, awkward, etc.
After the scenario
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Debrief the group
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(Training guide: Using simulation in TeamSTEPPS Training, n.d.)
D EBRIEF
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
Set the stage
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Arrange to encourage
discussion

Reemphasize safety
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Describe the expectations
for debriefing
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State your objectives
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D EBRIEFING DO ’ S
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(Diane, Tsang & van Shaik, 2011)
Acknowledge
and ask
Emphasize
and explore
Demonstrate
objective
observances
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Do..
Build, beliefs
and barriers
Correct and
collaborate
D EBRIEFING DO ’ S
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(Diane, Tsang & van Shaik, 2011)
Acknowledge
and ask
Emphasize
and explore
Demonstrate
objective
observances
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Do..
Build, beliefs
and barriers
Correct and
collaborate
D EBRIEFING DO ’ S
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(Diane, Tsang & van Shaik, 2011)
Acknowledge
and ask
Emphasize
and explore
Demonstrate
objective
observances
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Do..
Build, beliefs
and barriers
Correct and
collaborate
D EBRIEFING DO ’ S
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(Diane, Tsang & van Shaik, 2011)
Acknowledge
and ask
Emphasize
and explore
Demonstrate
objective
observances
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Do..
Build, beliefs
and barriers
Correct and
collaborate
D EBRIEFING DO ’ S
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(Diane, Tsang & van Shaik, 2011)
Acknowledge
and ask
Emphasize
and explore
Demonstrate
objective
observances
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Do..
Build, beliefs
and barriers
Correct and
collaborate
D EBRIEFING DON ’ TS
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Accuse
Sugar
coat
Blame
Criticize
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3 PHASES OF
DEBRIEFING
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
Description Phase

Analysis Phase

Application/Generalization Phase
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(Training guide: Using simulation in TeamSTEPPS Training, n.d.)
3 P HASES OF D EBRIEFING :
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D ESCRIPTION PHASE

Start by asking them to describe what emotions
they are feeling
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Recap the scenario
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Have one person do a brief one to two sentence
summary and others can add or subtract
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Team members share their perspectives on what
happened so everyone is on the ‘same page’
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(Training guide: Using simulation in TeamSTEPPS Training, n.d.)
3 P HASES OF D EBRIEFING :
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A NALYSIS P HASE
What went well?
Yourself
Saw in others
What didn’t go well?
Yourself
Team behavior
What would you do differently next time?
Yourself
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With others
(Training guide: Using simulation in TeamSTEPPS Training, n.d.)
3 P HASES OF D EBRIEFING :
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A PPLICATION / GENERALIZATION PHASE
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Team members describe
lessons learned
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Changes in practice

Changes in policy

Changes in procedures
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(Training guide: Using simulation in TeamSTEPPS Training, n.d.)
IN SUMMARY…
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
Debrief to promote reflection, discussion, and
learning

Create a safe environment
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Incorporate “Do’s” when facilitating a debriefing
and avoid debriefing “Don’ts”

Use the 3 phases of debriefing as guidance to
allow conversation to flow

Refer back to your scenario goal, challenges and
objectives to help focus the debriefing session
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D ISCLAIMER
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The contents of the following video are fictionalized.
All medical personnel appearing in the scenarios are
acting out assigned roles. Any resemblance to real
events and people, living or deceased, is entirely
coincidental.
The following video was filmed in a high fidelity
simulation setting. It is important to understand that
this level of technology is not necessary in order to
perform an effective pediatric mock code.
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V IDEO FACILITATING AND
D EBRIEFING
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Case #1
This is an example of a scenario
and debriefing from A to Z
Click Here
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Break time
10 minutes
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I NCORPORATING FACILITATING
AND D EBRIEFING
Case #2
Click Here
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I NCORPORATING FACILITATING
AND D EBRIEFING
Case #3
Click Here
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G REAT J OB !
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M AINTAIN THE G AIN
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Complete pre-code
needs assessment,
logistics, scenario and
evaluation creation
Analyze feedback
and report
suggestions to
staff and
management
Hold the pediatric
mock code
Evaluate feedback
from participants and
program members
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R ESOURCES
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
Resources available to you and your program

Mock code video scenarios

Pediatric Mock Code Toolkit

Train-the-Trainer PowerPoint Presentation

All resources are available online at
www.luhs.org/emsc
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R EFERENCES
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1. Topjian AA, Berg RA, Nadkarni VM. Pediatric cardiopulmonary resuscitation:
Advances in science, techniques, and outcomes. Pediatrics. 2008
Nov;122(5):1086-98.
2. Andreatta P, Saxton E, Thompson M, Annich G. Simulation-based mock codes
significantly correlate with improved pediatric patient cardiopulmonary
arrest survival rates. PEDIATR CRIT CARE MED. 2011;12(1):33-8.
3. von Arx D, Pretzlaff R. Improved nurse readiness through pediatric mock code
training. J Pediatr Nurs. 2010 10;25(5):438-40.
4. Hunt EA, Hohenhaus SM, Luo X, Frush KS. Simulation of pediatric trauma
stabilization in 35 North Carolina emergency departments: Identification of
targets for performance improvement. Pediatrics. 2006 03;117(3):641-8.
5. Mancini ME, Soar J, Bhanji F, Billi JE, Dennett J, Finn J, et al. Part 12: Education,
implementation, and teams: 2010 international consensus on
cardiopulmonary resuscitation and emergency cardiovascular care science
with treatment recommendations. Circulation. 2010 Oct 19;122(16 Suppl
2):S539-81.
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R EFERENCES
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6. Mikrogianakis A, Osmond MH, Nuth JE, Shephard A, Gaboury I, Jabbour M.
Evaluation of a multidisciplinary pediatric mock trauma code educational
initiative: A pilot study. J Trauma. 2008 Mar;64(3):761-7.
7. van Schaik SM, Plant J, Diane S, Tsang L, O'Sullivan P. Interprofessional team
training in pediatric resuscitation: A low-cost, in situ simulation program that
enhances self-efficacy among participants. Clin Pediatr (Phila). 2011
Sep;50(9):807-15.
8. Mann K, van der Vleuten C, Eva K, Armson H, Chesluk B, Dornan T, et al. Tensions
in informed self-assessment: How the desire for feedback and reticence to
collect and use it can conflict. Acad Med. 2011 Sep;86(9):1120-7.
9. Auerbach M, Kessler D, Foltin JC. Repetitive pediatric simulation resuscitation
training. Pediatr Emerg . 2011 Jan; 27(1): 29-31.
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R EFERENCES
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10. Fanning RM, Gaba DM. The role of debriefing in simulation-based learning.
Simul Healthcare. 2007 Summer;2(2):115-25.
11. Beaubien JM, Baker DP. The use of simulation for training teamwork skills in
health care: How low can you go? Qual Saf Health Care. 2004 Oct;13 Suppl
1:i51-6.
12. Training Guide: Using Simulation in TeamSTEPPS Training retrieved 1.2012 from
Link: http://www.ahrq.gov/teamsteppstools/simulation/index.html
13. Diane S., Tsang L, van Shaik, S.UCSF Children’s Hospital Mock Code Training
PowerPoint 2011 by the Regents of the University of California. Used with
permission.
14. Rudolph JW, Simon R, Rivard P, Dufresne RL, Raemer DB Debriefing with
Good Judgment: Combining Rigorous Feedback with Genuine Inquiry.
Anesthesiology Clin 2007 June; 25(2):361–376.
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T HANKS !
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