Transcript Branding in the Digital Age

Improving Care for Pediatrics
Nancy M. Tofil, M.D., M.Ed.
October 2011
Disclosure
• I have no conflict of interests to disclose
Overview
0-5min
Introduction/Turning Point Slides
5-15min
Objectives
15-45min Review Pediatric courses and
opportunities
45-60min TAPPS – List barriers and discuss
strategies to overcome to overcome
the barriers
60-75min Wrap-up / Top 10
How long have you been involved in
simulation?
17%
1.
2.
3.
4.
5.
6.
17%
17%
17%
17%
17%
2-5
years
>
5years
0-6months
6-12months
12-18 months
18-24 months
2-5 years
> 5years
0612-18
18-24
6month 12mont months months
s
hs
What is your role?
20% 20% 20% 20% 20%
r
th
e
O
st
ra
to
r
...
dm
in
i
ic
ia
n
ys
Ph
A
uc
at
ed
ur
se
/A
dv
or
...
te
c
N
m
ul
at
io
n
4.
5.
Simulation technologist
Nurse educator
Physician/ Advanced
provider
Administrator
Other
Si
1.
2.
3.
Who is your primary learner?
17% 17% 17% 17% 17% 17%
r
th
e
O
EM
T
..
fP
R
si
ci
a.
hy
id
e
nt
s
...
en
St
ud
es
St
af
ed
ic
al
N
ur
se
Nurse
Medical Student
Resident
Staff Physician
EMT
Other
M
1.
2.
3.
4.
5.
6.
Where is your center located?
ls
ic
a
r
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e
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...
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ed
In
rs
in
g
In
nu
ho
In
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sp
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ng
st
an
di
4.
5.
Free standing
In hospital
In nursing or allied health
school
In medical school
Other
Fr
ee
1.
2.
3.
20% 20% 20% 20% 20%
Which high-fidelity pediatric simulators do you have?
25% 25% 25% 25%
...
on
e
m
ar
d
M
or
e
th
a
G
n
au
ET
I
M
er
da
l
Laerdal SimBaby
Laerdal SimNewB
METI Child
Gaumard
More than one type
None yet
La
1.
2.
3.
4.
5.
6.
What do you feel is the biggest obstacle you face
concerning moving simulation forward at your
institution?
1.
2.
3.
4.
Financial related
Technical knowledge
Time constraints
Hospital support
What is your primary goal from this workshop?
1.
2.
3.
4.
5.
6.
Programming Advice
Ideas for pediatric sim
courses
Strategies to move your
center ahead
Product advice
Obtain new scenarios
Other
Learning Objectives
1. Discuss the medical/legal environment in the
pediatrics area
2. Identify issues specific to pediatric care
3. Describe the history of pediatric simulation
4. Describe the role of simulation in providing
quality pediatric education
5. Discuss collaboration with multidisciplinary
leadership
6. Describe how to plan and implement pediatric
simulation
7. Define measurable objectives for success
Medical/Legal Environment
1. Patient safety
2. Resident duty hours
3. Transition of responsibility to fellows and
attendings
4. Nursing students less exposure
5. New nurses less skilled
Issues Specific to Pediatrics
• Multiple sizes
• Multiple normal values
– Vital Signs
– Laboratory Values
– Radiograph findings
• Many patients unable to explain their concerns
• Interaction of care givers
• Social concerns
• Kids are never supposed to die
History of Pediatric Simulation
•
•
•
•
•
•
•
Laerdal SimBaby – released 2005
Laerdal SimNewB – released 2009
METI Child – released 2006
Gaumard HAL – released early 2000’s
Laerdal SimChild - soon
Always behind adult technology
Never will have as much potential profit
Hours of experience (in thousands)
Role of Simulation in Providing
Quality Pediatric Education
12
1. Clinical
Education
Inefficient
2. No Debriefing
3. No scheduled
admissions
10
8
6
4
2
0
First Year
Second Year
Third Year
Fourth Year
Years after professional degree
Old
New
1
Role of Simulation in Providing
Quality Pediatric Education
• John Dewey, “All genuine education comes about through
experience but not all experience educates and some
experience mis-educates”
• Experience is the backbone of adult learning theory
Kolb’s Experiential Learning Cycle*
Simulation
Concrete
Experience
Practicing
1.Standardize exposure
2.Scheduled debriefing
Reflective
Observation
Active experimentation
Debriefing
Abstract conceptualization
Relating to actual
situations, developing
rules, algorithms
*Kurt Lewen
Children’s of Alabama Pediatric Simulation Center
Began August 2007
8 Mannequins
3 Simulation rooms
Conference room
Audiovisual capability
in all rooms
• Storage
•
•
•
•
•
15,000 learners
Our Mannequins
•
•
•
•
•
•
•
SimBaby x2
SimNewB
SimMan
SimMan Essential
METI PediaSim
Gaumard Pediatric
Hal 1 Year
Gaumard Pediatric
Hal 5 Year
Multidisciplinary Courses
1.
2.
3.
4.
5.
6.
Radiology (Attending and Technologist)
ECMO (ECMO Team)
PICU (Physician, Nurse and Pharmacy)
Mock Code (Code Team)
Trauma (Trauma Team)
Death and Dying (Physician, Nurse, Social Work and
Chaplain)
7. Forensic Evidence (Physician, Nurse)
8. Medical Student Clerkship (Medical, Nursing and
Pharmacy Students)
9. Sedation (Physician, Nurse, Technologist)
10. Cardiovascular (Physician, Nurse Practitioner, Nurse)
ECMO
PICU
Mock Code
Trauma
Death and Dying
Forensics – Sexual Abuse Evidence Collection
“Silo” Courses
1.
2.
3.
4.
5.
6.
7.
Orthopedics
Anesthesia and CRNA
Pharmacy Student
PICU Nursing
Solid Organ Transplant Nursing
Dialysis Nursing
NICU Nursing
Orthopedics
Anesthesia and CRNA
NICU Nursing
Specialty Courses
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Nursing Skills Labs (First 5 Minutes of a Code)
PALS
Geriatrics
NRP
Clinical Assistant
New Hire Nursing Assessment
Sleep Technologists
Nursing Mock Code Orientation
Home Ventilator
Teen Trauma Prevention
Medication Errors
Geriatrics
Home Ventilator Simulation for Parents
Workshops
•
•
•
•
•
•
•
Tracheostomy
Intubation
Basic Airway
Surgical Airway
Crisis Resource Management
Intern Skills
ENT Foreign Body Removal
Basic & Advanced Airway
ENT Foreign Body Retrieval
Intern Skills
Where to begin
•
•
•
•
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Request comes in or need identified
Face to face meeting
Content expert identified
Learners identified
Goals and objectives
What simulation can and cannot do
Specific cases discussed
IDEAS FOR CASES
1.
2.
3.
4.
5.
6.
7.
8.
Sentinel events
Near misses
Rare events (contrast reactions)
Safety & equipment issues
Requests
Codes
Premature Closure
Hand offs
Process
•
•
•
•
•
•
Who? Learners, content expert, simulation staff
What? Objectives, take away points
When? Frequency
Where? Simulation Center, in situ, somewhere else
Why? Change in knowledge, skills, attitudes
How? Moulage, labs, xrays, equipment
RESOURCES
1. Online: forms, scenarios, programming, moulage
2. Internal: staff
3. Networking
4. Organizations
5. List serves
Make It Interesting
Moulage
Family members
Xrays, labs, ECG
Clothes, wigs, toys,
eyeglasses
• Voices
• Use real equipment (no
pretending)
• Unusual distracters (impaired
clinician, family issues)
•
•
•
•
Moulage
Accessorize
Evaluation: Generic
I am a
• MD
• RN
• Resp Therapy
• Pharmacist
• Radiology Tech
• Nursing Student
• Medical Student
• Chaplain
• Social Work
• Other_______
Agree
I found to be valuable learning experience.
Debriefing and group discussion were valuable learning
Experiences.
I will be able to apply what I have learned in my work
position/job.
I was challenged in my thinking and decision-making skills.
I developed a better understanding of the management of
pediatric disorders/emergencies.
This experience has increased my confidence level in pediatric
disorders/emergencies
This experience has increased my skill level in pediatric
disorders/emergencies.
I feel better prepared to care for real pediatric patients.
I learned as much from observing my peers as I did when I
was actively involved in caring for the simulated patient.
I would recommend this program to others.
The Instructor(s) was knowledgeable about the subject(s)
presented.
My personal objectives for this course were met.
Neither Agree
nor Disagree
Disagree
Evaluation
1.
Do you feel your participation in this course will improve your
performance as you encounter medical complications in the
actual clinic setting?
2.
Two things I liked/learned today:
a)
b)
3.
Two things I wish we had focused on or that could be
improved:
a)
b)
Comment/Suggestions/Recommendations:
TAPPS
• TAPPS – Think Aloud Paired Problem Solving1
•
•
•
•
Active Learning Technique
Pair up
Discuss proposed problem
As instructor state, “We will do this exercise for
___ minutes. I will give you a 1 min heads up.
At the completion of the exercise I will call on
some groups to share their thoughts. Does
anyone have any questions before we get
started.”
1. Harvey Brighton
Top 10 Things that Helped our Simulation
Center to Succeed
10. Simulator Voice
– 10W Guitar Amp ($60)
– RadioShack 170 MHZ wireless lapel
microphone ($50)
– 72inch LPM cable ($5)
PRICELESS
Top 10
9. Caregiver (parent, spouse, child)
– Hospital volunteer
– Medical student
Top 10
8. Free/ Nearly Free Supplies
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–
–
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–
X-rays
Laboratory reports
Costumes (thrift stores)
Trash bins (Stroller, IV pumps)
Expired medical supplies
Top 10
7. Short scenarios (10-15min) and
long debriefings (20-45min)
– Start with scenarios you feel most
comfortable with and expand from there
– Same stem for multiple learners – make it
more gray for more advanced learners
• JW, F8 def
– Change rhythms
Top 10
6. The Basic Assumption
Everyone participating in activities at the Children’s
Hospital Pediatric Simulation Center is intelligent, welltrained and dedicated to improve their care for
children.1
1. Adapted from Center for Medical Simulation, Boston MA
Top 10
5. Relatively simple video
system
– Video-switcher
• Picture in Picture
– Apple – I Movie
Top 10
4. Weekly simulation team meetings
– Keeps everyone accountable to each other
Top 10
3. Make friends – High and Low Places
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Housecleaning
Pharmacy
Engineering
Security
Hospital volunteers
Hospital CEO
Top 10
2. Candy!!
– Everyone learns more when fed!!
Top 10
1. Have fun and
keep it simple
Celebrate Success
I hear and I forget
I see and I remember
I do and I understand
Confucius, 551-479 BC