Stephanie Justice, MSN, RN Lisa Rohrig, BSN, RN The Ohio State University College of Nursing

EVERYONE’S INVITED:OUR INTERPROFESSIONAL SIMULATION EXPERIENCE

Stephanie Justice, MSN, RNLisa Rohrig, BSN, RN

The Ohio State University College of Nursing

About Us

Stephanie JusticeClinical Instructor in Technology Learning Complex

Lisa RohrigDirector Technology Learning Complex

Objectives

• Learn from our challenges and experience

• Leave with realistic, workable ideas

Purpose & BackgroundWhy do Inter-professional (IP) Sims?

• Institute of Medicine core competencies (2003)o Work in interdisciplinary teams

• Quality and Safety Education for Nurses (QSEN) (2005-12)o Knowledge, Skill & Attitude competencies of “Teamwork

and Collaboration”• Inter-Professional Education Collaborative (IPEC) (2011)

o Core competency domains • Values/Ethic for IP practice• Roles/Responsibilities• IP Communication• Teams & Teamwork

5 IOM Core Areas For Health Professions Education

Unscramble to reveal the 5 core areasTwo teams15 card holders per teamPut the word cards in order to list the 5 areasNo cheating!

5 IOM Core Areas For Health Professions Education

• Delivering patient-centered care• Working as part of interdisciplinary teams• Practicing evidence-based medicine• Focusing on quality improvement • Using information technology

Objectives

Not just working together…working together in

their role

And now a little comic relief…

Help!

Simulation Development• Opportunities

• History of IP Sims at OSU

• Planning committee

• What our Sim looks like now

Small Group BrainstormingDirections: form groups of 4-5 people each from a different facilityassign one person as timekeepereach person has 1 minute to list existing and potential collaborations

Collaboration ideas:• Programs within your facility

ex. midwifery and BSN• Outside hospital or college

independent schools or local hospital• Community provider

Could do squad run into simulated ED with nursing and EMS

Logistics

• Maximizing student participation

• Managing flow during simulation

• Managing resources needed

Student Availability

Simulation Schedule

“IP Sim Days”IP Sim Days Proposal:

• Designated set days each semester • Participating health science colleges “release” (their chosen

group of) students to participate in one IP simulation• Mandatory participation for designated student group• Sent to health science deans• Signed by all of the IP planning committee

Student Involvement Considerations• Matching levels of students

o Range of students that would be appropriateo Preparation may vary among levels of students

• Credit to studentso Pass/fail, clinical hours (depends on if allowed as

substitution), extra credit, professional development, volunteer

• Preparation varied among the professionso Slide show, case review, ISBAR overview

Small Group BrainstormingDirections: Form groups of 4-5 people; assign one person as timekeeper; each person has 1 minute to answer

Discuss:

• Which learners would be a good fit for participation in IP Sims at your facility?

• What types of preparation do you anticipate them needing?

• What incentives do you think might work best for your learners?

Logistics• Maximizing student participation

• Managing flow during simulation

• Managing resources needed

Logistics• Maximizing student participation

• Managing flow during simulation

• Managing resources needed

Space

Supplies and Equipment• Most supplies and equipment from nursing

• Some provided from other health professionso Therabando Acapellao Tube feeding

Personnel• Nursing currently does all set up/tear down

• Nursing provides majority of SPs

• RT leads the research

• Planning committee members facilitate debriefing sessions

Format • Our simulation focuses on communication and understanding

roles of other disciplines

• Students participate in the assessment, rounding, plan and treatment for each patient

• During first Sim we decided to add second rounds

Scenario Development• Reviewed 12 previous simulations as a group

• Looked for patients with complex needs that would require interactions between disciplines

• Took 6 months to choose and update patients to meet the needs of all groups involved

ISBAR rounding videoShort video (approx. 4 minutes)

ISBAR Video

Surprise!• We learned new terminology

Transfemoral• Proper titles

Medical Dietetics• Length of study for each program

Varies greatly• Who can do dressing changes?

Physical Therapy• What’s an Acapella?

Pickle

Missing ProfessionsScheduling conflicts… now what?

• Rounding reportso Created by each disciplineo First and second rounds

• One of the faculty in each Sim plays the part of the missing profession

• Pharmacy included additional information regarding medications and potential changes

Medical Records• EHR vs. Hard copy

CON has EHR but others don’t use it

• Needed to develop all parts of the chartLOS 4 days when Sim starts

Patient Care• After reviewing chart:

Each discipline assesses/meets with patient

• First roundsEveryone participates

• Implement/reassessImplement as much as possible

• Second rounds

Ann Arbor• MVA unrestrained DUI• Intubated on ventilator (respiratory failure)• Spleen laceration (post op)• Femur fracture – ORIF (post op)• Right chest tube to water seal• OG to suction (with drainage in suction canister)• Dobhoff in nares with tube feed (post-pyloric)• Foley

Ann’s Social History• Social Drinker

Was at a partyDoesn’t remember accident

• Retail job

• Steps at apartment

• Lives with roommate

Ann is a simulator• Can’t speak when intubated

Big problem for the simulationHow did we solve this problem?

• Can’t move when PT/OT works with herHow did we solve this problem?

What is next for Ann?• Possible change for spring simulation to Ann failing SBT or

pneumothorax

• May use an intubation head and live actorChallenges with this:

How to simulate working ventHow to simulate intubation, OG/NG on live patient

Jill Shuman• Post-op trans-femoral amputation• Pneumonia• History of ETOH and benzodiazepines• Post ETOH withdrawal• Bipolar and schizophrenic• Diabetic• Atrial fibrillation• PEG tube with tube feeding- on hold for Cipro• Foley pulled out

More about Jill• Added cultural considerations to simulation

Appalachian

• Complex social historyLast admission was >8 months ago

• Poor appetite

• Coumadin sub-therapeutic

Jill is a live person• How do we amputate the leg?

PT needs to wrap the residual limb

• Infected wound

• Complains of pain, numbness, tinglingTaught to rub legHold in different position when OOB

What is next for Jill?• May change scenario for spring • Experimenting with residual limb model• Add odor to infected wound

Debriefing• Created set of questions

• Keeps everyone involved

• Audiotape session Each person identifies which profession they are with

Debriefing Questions• Now that the simulation is over, what questions do you have

for another profession? (Remember, this is a safe environment)

• Name one thing you learned about another profession. (something they do or something they know, etc…)

• Let’s talk about the collaborations with the different professions during the simulation? o Who did you talk to? What did you talk about? o How did your conversations affect the patient’s plan of

care?

Debriefing Questions• Did you come to any new realization about your own profession’s

role/value on the team?

• Hypothetically, what if you had a conflict with another profession about their recommendation for the patients’ care, how should conflicts be addressed with another profession? o What is the time and place for conflict discussion? o How do you balance respect for another profession with

patient advocacy?

• What will you do differently in practice as a result of this experience

Research• Examining the potential benefits of clinical simulations on

teamwork and communication.

• The research will analyze the attitudes of participants toward the use of multi-disciplinary simulations in clinical education.

• RIPLS (Readiness for Interprofessional Learning Scale)

Qualitative Research Themes

Learning the roles of others

“I would hope that everyone from this takes away a greater respect for the other professions now that we understand what everyone does.”

“Rounds helped see what other professions do. Rounds helped us know what questions we can ask other professions.”

Qualitative Research Themes

The big picture

“So, it is kind of nice to hear everything that’s going on with the patient, to get more of an overview of everything that is going on.”

“You can see how you fit in the picture because when we do nursing sims it’s just all nurses so now you can see the bigger picture.”

Qualitative Research Themes

Increased trust and confidence

“It’s nice to know I can depend on other people to help me with what I do not know much about. It was humbling but also a confidence booster.”

“Something I have learned over the years is that nobody can do what they do without other people. Yea sure I’m the doctor but I can’t do my job without the rest of you guys.”

Qualitative Research Themes

Benefit of simulated setting

“You get a chance to make mistakes and learn from them; and not in a real setting where it’s kind of like fast paced…less stressful.”

Conclusions• Interprofessional education simulation demonstrated a

strategy to better prepare students for the clinical setting

• Reinforces what we see in the literature

• Future research is needed to explore the long term effects of participation

Questions??Stephanie Justice

justice.85@osu.edu

Lisa Rohrig

rohrig.1@osu.edu