The road to excellence

HEALTH SCIENCES SIMULATION CENTER

The Road to Excellence


Tell me

What is your background and where do you come from?

Hospital simulation centers

Nursing School Sim Center

University/Junior College Sim Center

Free Standing Sim Centers


Tell Me

Who has more than 10 years in simulation?

5-10 years

2-5 years

1 year or less?


2006 Maternal Mortality Rates per 100,000 live births

Iceland: 0 #1 ranking in world

Sweden: 2

Austria: 4

Canada: 6

Japan: 10

United Kingdom: 13

Singapore: 15

United States: 17


California Maternal Mortality Rates


Simulation Training Initiatives PROMPT-Draycott T. MD

http://www.prompt-course.org/home

STORC-OHSU:Jeanne Marie Guise MD

MOSES: St.Bartholomew School of Nursing and Midwifery and London Medical Simulation Centre,multidisciplinary obstetric simulated emergency scenarios

Obstetric Crisis Team Training. Wiser Institute.

MOES: Deering S, Rosen MA, Salas E, Simul Healthc. 2009 Fall;4(3):166-73.


JCAHO

Recommendations:

-conduct team training in perinatal areas to teach staff to work together and communicate more effectively

-for high-risk events, shoulder dystocia, emergency C-section, maternal hemorrhage and neonatal resuscitation, conduct clinical drills to prepare staff for when such events actually occur and conduct debriefing to evaluate team performance and identify area of improvement


Alta Bates

High volume

High Risk

>7000 deliveries a year

NICU

Urban Hospital Setting


Perinatal Team


Alta Bates Perinatal Group

1999: TLC program;

Teamwork

Leadership

Communication

Response to IOM report and low morale. Year long training before bringing to the unit.

1.) Core Meeting to review each patient, q shift 2.) Debriefings of all occurrences 3.) Adoption of SBAR standard of

communication among staff members.


Alta Bates Perinatal Group

2008: Formed a Simulation Committee to explore this methodology for staff education. CAPE: Center for Advanced Pediatric

Education; Stanford University. Lou Halamek MD

Two-day training for 13 core members.


Alta Bates Perinatal Group 2008 First Five Program: initial 5’ management of critical events

2009 Samuel Merritt University’s Health Sciences Simulation Center Course for L&D, Neonatal Emergencies Discussion and planning begins

2010 PROMPT shoulder dystocia training.

2010 NICU institutes NRP simulation training for all staff members and rotating residents.

2010 FHR recognition and standardized nomenclature training

2011 In-Situ Program begins.


Awareness

How many of you feel that your simulation center and capabilities are well known and integrated into the educational system of your parent organization or affiliated hospital systems?

How many of you are integrated into all your undergraduate and graduate training programs?


First MeetingPerinatal Plan and Design

September 13, 2009 first meeting with leadership from ABSMC. “Design a course to train our entire staff for

L&D,Neonatal emergencies.”

Lack of definition and clarity between the two parties regarding goals, allowed us both to develop completely different concepts.


Perinatal Project

November 25,2009 second meeting

Plan a Pilot program for introduction of sim to members of the L&D,NICU. Team training with nursing, ob, anesthesia.

Three 4-hour sessions of In-Situ sims at ABSMC. Three Scenarios.

After building departmental buy-in to sim, design a training plan for all members of L&D,NICU,OB, and anesthesia trained at HSSC over 10 months. 170 RNs.


What they said:12/2/09

“The goal would be to train all the FT RNs and many of the PT RNs. (176)

“Each 4 hour training period would train 2 teams of 3RNs / 2MDs in 3 scenarios, scheduled as two 4-hr sessions per day, twice a month for 8 months.” (3rn+2md) x 2/d x 2/mo x 8mo=

This would be 96 RNs and 64 MDs!!

13 member Team training 1 or 2 days

In-Situ training assistance 8hours x 6 days training a total of 12 RNs in three months.


WHAT I HEARDDecember 18,2009

“I am hearing this to mean that we will use two simulation suites here at our center,

running two sessions per day,

of four hours duration,

performing three scenarios for five learners;

3RNs/2MDs.

20 learners/day x 2d/month x 8 months= 320!

With 192 RNs and 128 MDs.”


WAS

WAS I OUT OF MY MIND!!

I JUST OFFERED TO COMMITT 10 STAFF MEMBERS AND OUR ENTIRE FACILITY FOR 8 HOURS A DAY, TWICE A MONTH, FOR 8 MONTHS.

WE HAVE A STAFF OF 4.

KNOW YOUR LIMITATIONS.

PROMISE SMALL, DELIVER BIG.


SandSanjeet Gill, HSSC south lab director; Jeanette Wong BSN,MPA,Operations Manager; Kevin Archibald, Admin Assist; bill, Lina Gage-Kelly RN,Simulation Coordinator; Celeste Villanueva CRNA,MS, Director of HSSC, Director of the Program of Nurse Anesthesia Samuel Merritt University


HSSC ProposalDecember 18,2009

Case One: Team Training 13 members,2 days= $26,000

Staff Training: 320 members,8mos= $80,000

$106,000

Case Two:Team Training = $26,000

3 Months In-Situ Assistance= $30,000

$56,000


Affiliated Discounts?

How many programs have fee schedules that differ for their affiliated institutions vs outside clients?

How much is that discounted rate? 10-20%? 30-40%? 50-60%? 70-80%?


HSSC: Real Costs Develop Program: 40 hrs@$125=$5000

Core TeamTraining: 16hrs@$250=$4000

Simulation: 40 sessions,160hrs SBT@$320=$51200

In-Situ Training: 48hrs@$50=$2,400

Supplies:40 sessions@$150=$6000

Equipment depreciation:28d@$150=$4200

Food ………………………………..$2025

Total---------------------------------$76,850

Total Hours: 264


Agreement

PHASE I Program Development: 40 hrs

PHASE II Team Training: 16 hrs

PHASE III In-Situ Faculty assist: 48 hrs

Total hours: 104


Final ContractPhase I

Phase I: Only Core Team (9), 40 hrs. Location: HSSC Course design, scenario selection, writing

scenario objectives, writing scenarios, programming into software, operation of software, vetting and validation, dress rehearsal, and debrief.

.


Phase ITimeline


Phase I


Phase I


Celeste Villanueva Excels at Processes


“I don’t know what I want!”


Objectives


Learning Objectives are Key

ABSMC had 3 Distinct Primary Learning Objectives

1. Learning objectives of Core Team

2. Learning objectives of Trainers in Training

3. Learning objectives for In-Situ learners


1.Core team objectives


Phase ITwo Teams Emerge

Different Objectives Labor and Delivery Team

PPH, Eclampsia, Cord Prolapse, Shoulder Dystocia, Code C, Breech delivery.

NICU Team Neonatal Resuscitation Protocols


2.Trainers in Training objectives


3.In-Situ Objectives

.1. State the major components of maternal-child emergency response protocols according to the Alta Bates obstetrical and neonatal guidelines.

2. Endorse the standardized obstetrical and neonatal emergency response protocols for Alta Bates, based on debriefing responses and post-session evaluations

3. Demonstrate the ability to perform assigned roles in a coordinate response to per/neo-natal emergencies according to AB obstetrical and neonatal guidelines.

4. Execute the essential skill sets required to complete the roles and functions of the assigned role, according to AB specific practices.

5. Employ/Demonstrate best practices skills of team communication, indicated by adherence to AB defined definitions of SBAR, briefings, and call-backs

6. Engage in self-reflective learning and practices, as indicated on post-session evaluations and feedback from debriefers.


Secondary Learning ObjectivesUnique to the Scenarios


Critical Elements

Essential actions, demonstrations, or communications by the learners that are required for successful completion of the scenario.


Select the subject of scenarios

Best to use real case experience Sentinel events Root Cause Analysis Near Miss data

Gives a voice to the objectives

Build scenarios backward from objectives


SMU Template


Phase IITrainers in Training

Phase II 16 hours:

Simulation Committee members (19) Location: HSSC Members of the Simulation Committee and the

Core team members first validate, vett, and amend the scenarios. Then execute the four scenarios, assume all the roles required, instruct, mentor, and orient the TnT’s to simulators, environment, scenarios, and debriefing.


Herding Cats


Trainers in Training Dress Rehearsal


Roles


Phase III

Phase III:48 hours: In-Situ Simulation Team in Training members; 6 days, 8 hours

of in-situ training for L&D RN staff. Execution by Core Team. Manikins, video, computers, mentoring, and debrief assistance supplied by HSSC staff.

104 Total hours: all three Phases


In-SituDress Rehearsal March 15,2011

Difficulty of In-Situ sessions: Room not available Short staffing calls Distractions to staff Inconvenient to patients No suitable spaces

Must be flexible!!

Make it work.


In-SituDress Rehearsal March 15, 2011

Advantages of In-Situ Work with your own

environment Systems issues revealed Familiarity is not distraction Increased fidelity Abundance of resources Administration can pop in!


DebriefingMake it Comfortable

On the day of In-Situ dress rehearsal no conference space was available so the team debriefed in the nurse managers office.

Debriefing space was not close-by.

Audio/Video limited Small Spaces Too hot Learned for next time!! Better to move downstairs to

conference room with space and A/V.


Debrief the Rehearsal

Members of the entire team review issues of realism, sequencing, moulage, dialogue, and fulfilling of roles.

Note taking scribs all debriefing elements for summative emails and discussions in follow-up.


The Big Day March 29,2011


Active Learners have been assignedTeam Leaders Pre-Brief


Debriefers have been assigned


“I don’t want my picture taken” Orientation to Simulation

Safety of the environment Not Evaluative Discuss the power of self

reflection. That’s why we video.

Its practice!! If you know it why worry, if you need help this is the place.

No harm no foul. Celebrate mistakes. Las Vegas rule. Honor code.


Confederates

Confederate “patient” is mic’d and reviewing her role with Team members Megan and Kristin.

Team Leaders communicate with confederates & operator via walkie talkies.

Consider scripting dialogue for confederates.

Know your roles, be able to react to learner behaviors


Action Team and Observers


Room Set-Up


Timing and Coordination


Debriefing are Comfortable and Safe


Category 1 Category 2 Category 3 Category 40

1

2

3

4

5

6

Series 1Series 2Series 3


Lessons Learned

Do the hard work up front.

Define the Goals and work backward from there to the beginning.

Engage all members of the team.

Share the responsibilities among RNs and MDs to gain both perspectives

Identify a small group of Core champions.

Evaluation Tools for Teams.

Work closely with RN union.

Be methodical and realistic.

Schedule and Plan and then do it again.

Keep good debriefing notes of all meetings and rehearsals.

Don’t use more fidelity than you need.

Confirm your space and availability.

Use the learning objectives to guide debriefings.


Next Steps

Twice monthly In-Situ training with HSSC faculty assist. Then independently.

Select Simulation equipment needs

Incorporate more of the scenarios

Develop didactics and educate staff.

Distribute Team in Training members to use fewer per session.


We got to HANG THE MOOSEHEAD!


Perinatal Project

Building Buy-In Where is the pain?

Bad outcomes raise insurance premiums.

Mandated by hospital Administration.

Began Discussions with med-mal insurer about premium discounts for completion of risk reduction course.

What would the insurer like to see in this course?


CRICO and RMF

CRICO: The Controlled Risk Insurance Company

RMF: Risk Management Foundation

Both of Harvard Medical Institutions, promoted sim-based team training as a risk control strategy for OB providers. Patterned after the successful Anesthesia program.

Simulation in Healthcare: vol.3,No 2, 2008. Gardner R, Raemer D, et al.


CRICO

The course was designed around Closed Claim ob cases of Harvard affiliated Perinatal units as the basis for simulated cases involving teamwork and communication.

In 1 year follow up surveys, 87% said they had experienced a critical clinical event since the course and that various aspects of their teamwork had significantly or somewhat improved as a result of the course. 89% said the CRM principles were useful and 59% recommended repeating q 2yrs.


CRICO

The course is now a central component of CRICO/RMF’s obstetric risk management incentive program that provides a 10% reduction in annual malpractice premiums. Approximately $6000/per physician.

Too early to know if it has changed claims. However, the same program for anesthesia was so successful that premium incentives were raised in 2007 to 19% for participants.


The Doctors Company

Patient Safety First: online program built around the most common types of OB claims, rewards physicians who successfully implement the patient safety steps.

Offering a 10% premium discount


Requirementsare combersome

Complete the Perinatal Bundle of Courses (Advanced Fetal Assessment and Monitoring, Managing Shoulder Dystocia, Operative Vaginal Delivery, and SBAR+R: Structuring Communication in Healthcare) offered online through Advanced Practice Strategies (APS). Access to these courses is available to you through our online member login at www.thedoctors.com.

Develop written protocol for communication (SBAR+R or similar) between you and the labor and delivery nurses to be utilized in the event that any of the following situations occur:

Nonreassuring fetal heart rates using the guidelines as outlined in the APS Advanced Fetal Assessment and Monitoring course and any other change in the fetal tracing that you feel is reportable

Elevated systolic BP of >140 mm Hg or diastolic BP of >90 mm Hg Vaginal bleeding Meconium Suspected abnormal presentation Elevated maternal temperature >100.4 or per

hospital protocol Other criteria occur that you have identified (e.g., rise in fetal heart rate baseline of greater than 10 bpm,

more than five variable decelerations in X minutes, etc.)

Post the communication protocol in L&D, and implement it in coordination with nursing leadership.


The Doctors Company

We are working with TDC to satisfy their patient safety requirements for receiving the same 10% premium discount.

Following the CRICO formula for simulation based risk reduction.



OUTLINE Statistics about OB safety

Perinatal Team and their commitment to excellence

Simulation and Team Training

Plan and Design of Simulation Program

Budget and Schedule

Training

Rehearsals

In-Situ Experience

Date post:	07-Nov-2014
Category:	Education
Upload:	bstiers
View:	519 times
Download:	1 times