Transcript Welcome [www.laerdal.com]

Welcome
‘Teaching Patient Safety’
Laerdal SUN 2009
San Francisco, California
October 21, 2009
Brief Introduction
• Laura Mosesso
– Project Manager, SimMedical
• Aimee Smith
– Production Manager, Curriculum Development
WISER/SimMedical
Agenda
• Tell us about you!
– Audience Response System
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What are Response Teams and Initial Responders?
Simulation Session
Debriefing Exercise
Curriculum Exercise
Courseware Review
Question and Answer Session
What is your primary role at your
facility?
1. Clinician
2. Clinical Educator
3. Educator (Not
clinically active)
4. Administrator
5. Simulation Operator
6. Other
If you are a clinician, tell us more!
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1. RN
2. MD
3. Respiratory
Therapist
4. Paramedic / EMT
5. Other
Why are you here?
Are you interested in…
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1. Rapid response team training
2. Initial in-hospital responder
training (prior to code team
arrival)
3. Learning what others are
doing
4. Looking for ways to improve
what you are already doing
What are you currently doing for
Team or Initial Responder training?
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1. Course material only
2. Course material and
simulation sessions
3. Simulation sessions
only
4. Not teaching
Why Simulation-Based Training?
In the United States:
• Average 1.2 million healthcare related incidents per
year
• $29 billion a year associated with medical errors
• 66% of medical errors are associated with
communication issues
Why Simulation-Based Training?
According to the 1999 Institute of Medicine
Report ‘To Err Is Human’, approximately
100,000 Americans die each year from
‘preventable’ hospital errors. The annual
toll exceeds the combined number of
deaths and injuries from motor vehicle
and airline crashes, suicides, falls,
poisonings and drownings.
Why Simulation-Based Training?
To Err Is Human; Building a Safer Health System
“The Committee believes that health care
organizations should establish team training
programs for personnel in critical care areas
(e.g., the emergency department, intensive
care unit, operating room) using proven
methods such as the crew resource
management techniques employed in
aviation, including simulation.”
WHAT is a Rapid Response Team?
• Also known as Crisis Team (CT), Medical Emergency Response
Team (MET) or Code Team
– Teams of clinicians rush to a patient’s location whenever a
clinician feels the patient’s condition is deteriorating or has
deteriorated
– Teams are designed to rescue patients early in their decline,
before an adverse outcome occurs
• Hospitals using Rapid Response Teams report reductions in the
number of cardiac arrests, unplanned transfers to the ICU and
in some cases, overall mortality rates
WHY Rapid Response Team Training?
• The Joint Commission
– 2008 National Patient Safety Goals
• Goal 16: Improve recognition and response to changes
in a patient’s condition.
o 16A: The organization selects a suitable method
that enables health care staff members to directly
request additional assistance from a specially
trained individual(s) when the patient’s condition
appears to be worsening
WHY Rapid Response Team Training?
• IHI: Institute for Healthcare Improvement
100,000 Lives Campaign
– Introduces proven best practices to extend or save as
many as 100,000 lives by reducing morbidity and mortality
– Activating a Rapid Response Team is one of six strategies to
prevent avoidable deaths
• Deploy Rapid Response Teams…at the first sign of
patient decline
WHAT is an Initial Responder?
• Wikipedia
– Initial or First Responder is a term used to
describe the first medically-trained responder to arrive on
scene of an emergency
– The first stage of being a first responder is being able to
recognize what it is that you are required to know and
perform the necessary interventions
WHY Initial Responder Training?
• To address CRITICAL INCIDENTS
– High percentage outside critical care areas
– Survival highly dependent on Initial Responders
– Multiple factors influencing patient outcomes include:
• Patient co-morbidities and initial cardiac rhythm
• Duration of incident and time to defibrillation
– Need for rapid and effective BLS and ACLS
WHY Initial Responder Training?
• Importance of sufficiently trained personnel
– Perform effective BLS
– Initiate early intervention and defibrillation if needed
• AED utilization
– Less intimidating
– Support rapid defibrillation
WHY Initial Responder Training?
• On average, greater than 9 minutes to shock patient
• Less than 10% of patients are provided proper BVM
ventilation
• 40% of nurses did not know the correct phone
number to activate the Rapid Response Team
• Patient report was inconsistent
• 80% of nurses did not set the defibrillator to the
appropriate mode
How do you run scenarios?
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1. On the fly
2. Programmed but always
tweaking
3. Preprogrammed
How do you debrief?
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Record video
Use checklists
Collect data
Utilize Laerdal software and
hardware
5. Other
Simulation Scenario
• 3 volunteers needed
• 3-5 minute scenario
• Observers - please take notes to debrief as
you would normally at your organization
• Volunteers - scenario orientation to:
– Setting
– Equipment
– Roles
Patient Report
Location: Non-Monitored Bed Unit
Patient: William Roberts
Patient Information: 82 year old male postoperative for hernia repair
Past Medical History: Myocardial Infarction
(4 years ago)
Meds: Aspirin daily
Debriefing Exercise
Please share 1 -2 of your debriefing points.
Problem with current debriefing
methods (pick your greatest pain)
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1. Too many instructors
debriefing differently
2. Ineffective assessment
tools
3. Lack of standard
debriefing points
4. Inconsistent scenario
progression
Tools
• Think back to the scenario…let’s discuss the
following:
– Would tools have helped with the assessment?
– Do you feel tools would help relate the debriefing
to scenario objectives?
– Would tools provide standardization to the
instructor community?
– Is it important to assess the same way with each
training / scenario session?
Scoring Tools Exercise
• Think back to the scenario…
– Use the Assessment Tool to document volunteer
actions during the scenario
• Let’s discuss the following…
– Standardized debriefing points
Scoring Tools
• Standard assessment and debriefing tools help to
– Keep instructors focused
– Clearly outline learning objectives
– Structure debriefing sessions
– Gather valid research data
These are all common problems in simulation-based training
today!
What is a Course?
COURSE
Before Class
During Class
After Class
Based on the above information, please share
your thoughts on what would go into each
category.
What is a course?
COURSE
Before Class
During Class
After Class
Participant content
Lecture
Assessments
Instructor content
Simulation
Debriefing
Partnerships
• SimMedical, in partnership with Laerdal Medical, is
pioneering simulation-based education materials
• Joint venture offers curricula / courseware that is:
– Developed by board-certified clinicians and other content
experts
– Designed with simulation educational methodology that
incorporates healthcare best practices
– Created with a variety of learning techniques to maximize
retention of material
The First 5 Minutes®
All the materials needed to deliver a robust simulation course
• Course Goals:
– Early recognition of critically ill hospital patients before the
code team arrives promoting improved outcomes
– Establish standardized behaviors for the initial hospital
responders
• Target Audience:
– Healthcare staff that are the initial responders to a patient
in crisis such as non-critical care nursing staff, nursing
students, respiratory therapists, physical/occupational
therapists, et al.
The First 5 Minutes®
• Why?
– Floor nurses and other hospital staff are
undertrained or are not trained to deal with
patients in crisis
– Teaches staff how to manage patients in crisis
prior to the actual code team’s arrival
– Part of a hospital quality patient safety program
– Meets regulatory requirements
Rapid Response Team Training
Simulation-based educational training program
• Course Goals:
– Develop critical team building skills
– Improve communication
– Promotes efficient teamwork
• Target Audience:
– Clinicians who are part of the actual code team that take
over from the initial hospital responders
– Roles include physician, nurse, pharmacist, and
respiratory therapist
Rapid Response Team Training
• Why?
– Promotes the fundamentals of teamwork
– Emphasis on communication
– Strong focus on the importance of practice
– Meets regulatory requirements
– Developed by Michael DeVita, MD
• International leader in rapid response systems and
simulation training
• Current President, Society for Simulation in Healthcare
SimMedical Courseware – Solutions Focused
For the Instructor
• Full suite of structured materials - including didactic materials,
quizzes, surveys, evaluations, scenarios, and debriefing tools
• Assists with the didactic presentation, the product contains indepth instructor actions to assist in teaching
For the Participant
• Includes Participant Guides – individual workbooks for each
participant, along with supplemental learning aids
For the Simulation Operations Staff
• Supports all aspects of simulation by including pre-programmed
scenarios, detailed room setup guides, equipment lists, and
supplemental materials
Courseware