Paris Hotel and Casino Las Vegas Nevada Presented by Jennifer Sweeney MSN RN CEN Advanced Practice Program Coordinator Center for Advanced Surgery amp Simulation Sarasota Memorial Health Care System ID: 919225
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Slide1
Improving Bedside CPR Skills and Team Skills with In-Situ Simulations
Paris Hotel and Casino
Las Vegas, Nevada
Presented by
:
Jennifer Sweeney, MSN, RN, CEN
Advanced Practice Program Coordinator
Center for Advanced Surgery & Simulation
Sarasota Memorial Health Care System
Presenter Disclosure Information
Jennifer Sweeney, MSN, RN, CENImproving Bedside CPR Skills and Team Skills with In-Situ
Simulations.No relevant financial relationships exist
.
Slide3Random In-situ Critical Event Simulation
Improving
CPR skills and teamwork for providers at the hospital patient’s bedside.This presentation will demonstrate the design and implementation of the programGarnering stakeholder
support.Tools to produce measurable outcomes.Results from 12 months of data collection.
Slide4BackgroundSMHCS is a 806-bed regional medical center.
4,000 staff, 802 physiciansLarge simulation center with 8 High fidelity simulators, 1 Program Coordinator, 0 Simulation Technicians Florida “seasons” make in-lab training difficult to schedule most of the year.
Financial constraints necessitated driving the simulation program out to the bedside.
Slide5Problem:Needs
assessment revealed concern with direct care providers’
comfort and confidence with recognizing and responding to emergent patient care situations.Concern with cost involved with lengthy simulation classes, loss of productive time, scheduling concerns, etc.
Fear in the first five minutes.
Slide6Solution:Short critical event scenarios are simulated in the actual areas these events may take place.
TeamSTEPPS principles integrated
into scenario planning and debriefing. Simulations last no longer than 20 minutes including pre-briefing, conduction of the simulation, and debriefing of all providers involved. Results shared with the unit educator and manager for further review, in–depth debriefing, and ongoing staff education.
Slide7TeamSTEPPS:Team Strategies
and Tools to Enhance Performance and Patient SafetyFREE, Evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.
http://teamstepps.ahrq.gov/
Slide8Scenario SelectionInterdisciplinary
Short critical eventsIN-SITUImpromptuWhat scare you the most?
Focus on patient safety and teamwork!
Slide9Garnering SupportKeep
it quick: in and out as fast as possible.
Meaningful: set clear and realistic objectives.Interprofessional: look for your champions.Budget neutral: high fidelity, low fidelity, no fidelity.
FOCUSED on PATIENT SAFETY. Build it (Hype it) and they shall come!
Slide10Implementation
Conducted in-situ for no longer than
20
minutes with
any/all
health care team members working at that time:
-
10 minutes for conduction of the simulated event and 10 minutes for debriefing of all providers involved.
Video recorded for educational review at a later time (staff meeting, huddle, end of shift).
Debriefing focused on identification and immediate correction of latent safety threats and principles
of
TeamSTEPPS.
Always have “crowd controllers” to communicate with patients and visitors during the exercise. Big crowd pleaser!
Just do it! The program and results sell themselves!
Slide11RISCE Simulation in OB ECC
Goal:
Test new communication plan for rapidly summoning help to new unit and overall emergency preparedness of new unit.
Debriefing:
Latent Safety Threat Identified:
Operator paged out location incorrectly causing delay in arrival of NICU Team. Follow up meeting scheduled that day to correct.
TeamSTEPPS:
Excellent demonstration of Mutual Support- Concern voiced by physician to increase speed of compressions. Team did not respond. Physician began counting cadence aloud. Room for improvement noted in use of call outs and check backs between Respiratory Therapist and Nurse.
Time:
8 minute Scenario, 5 minute Debrief
RN
MD
RT
Slide12EvaluationTool Selection:
Quantitative Data for the number crunchers.
Qualitative data for the emotional impact.Baseline data to compare to ongoing data.Look for tools that are already validated, reliable, have been utilized in other programs, etc.
TeamSTEPPS tools.
Slide13OutcomesPost-RISCE
participant evaluation tool: Perceptions are evaluated per session and for improvements over time.
Review of the RISCE simulation video:TeamSTEPPS behaviors Scored as consistently applied ‘1’, inconsistently applied ‘0.5’, or absent ‘0’. BLS
/ ACLS guidelines: Recommended practice is compared to actual performance. Video breakdown
Slide14Slide15Slide163/29/2012
6/10/2012
9/13/2012
12/16/2012
2/4/2013
Start time to recognition
0
10
10
15
10
Start time to call for help
0
30
10
15
25
Start time to start CPR
50
60
30
42
33
Start to arrival of AED
100
140
65
60
60
Start to use of AED
150
170
95
97
86
Start to Code Blue arrival
210
140
65
180
95
Compressor 1 time before switch
140
220
60
200
150
Compressor 2 time before switch
Time off chest 1
20
40
15
18
20
Time off chest 2
10
30
12
30
10
Time off chest 3
35
20
Time off chest 4
12
Safety threat 1
long delay from recognition to response
Order should be directed to a particular person, then repeated back by that person. Poor closed loop communication
Multiple calls made to ensure code team and NICU team were en route, need better closed loop communication
Code Blue did not have badge access through new door
RN did not visually clear team before delivering shock.
Safety threat 2
long time off chest
Long breaks in chest compressions
Infant resuscitation area missing needle decompression supplies
Safety threat 3
Safety threat 4
Questions?Jennifer Sweeney, MSN, RN, CENSarasota Memorial Health
Care SystemJennifer-sweeney@smh.com
941-917-1761
Slide21ReferencesEdelson DP, Litzinger B, Arora
V, Walsh D, Salem K, Lauderdale DS, Vanden Hoek TL, Becker LB,
Abella BS. (2008). Improving In-Hospital Cardiac Arrest Process and Outcomes With Performance Debriefing. Arch Intern Med.168(10):1063-1069.Gillespie BM, Chaboyer W, Murray P. (2010). Enhancing communication in surgery through team training interventions: a systematic literature review. AORN J. 92:642-657.
Halverson AL, Andersson JL, Anderson K, Lombardo J, Park CS, Rademaker AW, Moorman DW. (2009). Surgical Team Training: The Northwestern Memorial Hospital Experience. Arch Surg.144(2):107-112.
Siassakos D, Bristow K, Draycott TJ, Angouri J, Hambly H, Winter C, Crofts JF, Hunt LP, Fox R. (2011). Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross-sectional study. Simul Healthc
. 6(
3):143-9.