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eSimulation in ActioneSimulation in ActionKettering Medical CenterKettering Medical Center
Sharing Our Success Story Sharing Our Success Story and and
StrategiesStrategies
Laerdal Simulation Users NetworkLaerdal Simulation Users NetworkDianne Ditmer, PhD, RN, CFN, DABFN, FACFEDianne Ditmer, PhD, RN, CFN, DABFN, FACFE
Improving the quality of life Improving the quality of life for the people in the communities for the people in the communities
we serve. we serve. Mission Statement Kettering Medical CenterMission Statement Kettering Medical Center
KETTERING HEALTH NETWORKKETTERING HEALTH NETWORK
Kettering Memorial HospitalKettering Memorial HospitalSycamore HospitalSycamore HospitalKettering Behavioral Medicine CenterKettering Behavioral Medicine Center
Grandview Medical CenterGrandview Medical CenterSouthview Medical CenterSouthview Medical CenterGreen Memorial HospitalGreen Memorial Hospital
And GrowingAnd Growing……....
Our Commitment To ExcellenceOur Commitment To ExcellenceRecognition as Top 100 HospitalsRecognition as Top 100 HospitalsCenters of ExcellenceCenters of Excellence
Stroke CenterStroke CenterChest Pain CenterChest Pain CenterBariatric CenterBariatric CenterJoint Replacement Center Joint Replacement Center Cancer CenterCancer Center
Premier Q AwardPremier Q AwardJD Powers Distinguished Hospital Service JD Powers Distinguished Hospital Service ExcellenceExcellenceBest Place to WorkBest Place to WorkMagnet designation 3 campusesMagnet designation 3 campuses
High achievement always takes High achievement always takes place in the framework of high place in the framework of high
expectation.expectation.Charles F. KetteringCharles F. Kettering
ObjectiveObjectiveEvaluate and implement a Evaluate and implement a comprehensive online staff development comprehensive online staff development programprogramPrioritiesPriorities
HeartCodeHeartCode BLSBLSHeartCodeHeartCode ACLS ACLS Integration of Simulation Integration of Simulation
Background By The NumbersBackground By The Numbers
2250 staff required to maintain BLS 2250 staff required to maintain BLS competencycompetency
30 BLS course offerings30 BLS course offerings
5 courses per month January 5 courses per month January –– JuneJune
80 students per course80 students per course
14 BLS Instructors per course offering14 BLS Instructors per course offering
Background ChallengesBackground ChallengesOff campus facilityOff campus facility
Accommodate large volumes Accommodate large volumes Staff travelStaff travel
EquipmentEquipmentInstructorsInstructors
VolumeVolumeAvailabilityAvailabilitySchedulingSchedulingInterpretation of competencyInterpretation of competency
Staffing scheduleStaffing scheduleChallenge for CNMChallenge for CNMReplacement staffReplacement staffBudget variances Budget variances
Long linesLong linesRefreshmentsRefreshments
Survey The SceneSurvey The Scene
What is the most important issue?What is the most important issue?Connect everything we do to clinical Connect everything we do to clinical outcomesoutcomesSupport the staff at the bedsideSupport the staff at the bedsideEnhance knowledge and competencyEnhance knowledge and competencyAcknowledge learning styles and needs Acknowledge learning styles and needs
Survey The SceneSurvey The Scene
What keeps you up at night?What keeps you up at night?New grads on the night shiftNew grads on the night shiftKeeping core competencies solidKeeping core competencies solidFocusing on patient needs while supporting Focusing on patient needs while supporting staff needsstaff needsClinical excellence, staff excellence while Clinical excellence, staff excellence while meeting financial targetmeeting financial targetTime managementTime managementRegulatory complianceRegulatory compliance
Survey The SceneSurvey The Scene
What do you enjoy most about your What do you enjoy most about your profession?profession?
Collaborative practiceCollaborative practiceMultiMulti--disciplinary approachdisciplinary approachPositive, measurable outcomesPositive, measurable outcomesNurturing staff growthNurturing staff growthSelf governanceSelf governance
Survey The SceneSurvey The Scene
How do you use the Internet?How do you use the Internet?ShoppingShoppingAccess information, musicAccess information, musicEducational resourcesEducational resourcesTravel planningTravel planningSocial networksSocial networksConnections to family and friendsConnections to family and friendsNewsNewsDigital photographyDigital photographyFinancesFinances
What We Were Searching ForWhat We Were Searching ForCost effectiveCost effectiveEvidenceEvidence--basedbased
Inadequate training of nurses is a factor in Inadequate training of nurses is a factor in 58% of serious errors 58% of serious errors (The Joint Commission in Block, (The Joint Commission in Block, ClaffeyClaffey, , KorowKorow & McCaffrey, 2005)& McCaffrey, 2005)
User friendlyUser friendlyReplacement two times salary Replacement two times salary (Barton, Goudy & Hawthorne, 2005)(Barton, Goudy & Hawthorne, 2005)
Easily accessibleEasily accessibleImprove clinical outcomesImprove clinical outcomesRegulatory complianceRegulatory complianceReduce monitoring time by Nursing Reduce monitoring time by Nursing Leadership and EducatorsLeadership and Educators
They just donThey just don’’t get it!t get it!
You teach the same thing over and over but You teach the same thing over and over but they just canthey just can’’t remembert remember……
Sensitivity To Levels Of ExpertiseSensitivity To Levels Of ExpertiseWhat Type Of Support Do They Need?What Type Of Support Do They Need?Novice: experienced nurse in a new settingNovice: experienced nurse in a new setting
Advanced Beginner: new graduate nurseAdvanced Beginner: new graduate nurse
Competent: 2 Competent: 2 --3 years clinical experience3 years clinical experience
Proficient: Nurse clinicians, nursing facultyProficient: Nurse clinicians, nursing faculty
Expert: Advanced practice nurse clinicians Expert: Advanced practice nurse clinicians and faculty and faculty (Benner in Zerwekh & Claborn, 2006, p 14)(Benner in Zerwekh & Claborn, 2006, p 14)
Sensitivity to Generational Sensitivity to Generational Differences and Learning StylesDifferences and Learning StylesTraditionalists Traditionalists –– 5%5%
Written Written –– Visual LearnersVisual LearnersBaby Boomers Baby Boomers –– 45%45%
Love meetings Love meetings -- AuditoryAuditoryGeneration X Generation X –– 40%40%
Video game and PC pros Video game and PC pros Stimuli, multiple strategiesStimuli, multiple strategies
Generation Y Generation Y –– 10%10%Grew up on the Internet, eGrew up on the Internet, e--mail, mail, FacebookFacebookInstant feedback, visual and tactileInstant feedback, visual and tactile
(Dittman, 2005)(Dittman, 2005)
Business PlanBusiness PlanDeveloped and presented a business plan to Developed and presented a business plan to Nursing Leadership and AdministrationNursing Leadership and Administration
Identifying needs Identifying needs
Listing initial and longListing initial and long--term coststerm costs
Calculating longCalculating long--term savings to the term savings to the healthcare systemhealthcare system
Cost AnalysisCost Analysis2007 Traditional BLS2007 Traditional BLS 2008 HeartCode BLS2008 HeartCode BLSRegistered Nurse $354.38Registered Nurse $354.38 Registered NurseRegistered Nurse $41.00$41.00
Licensed Practical Nurse $322.00Licensed Practical Nurse $322.00 Licensed Practical NurseLicensed Practical Nurse $41.00$41.00
Nursing Assistant Nursing Assistant $244.86$244.86 Nursing Assistant $41.00Nursing Assistant $41.00
Registered Nurse $556,376.60Registered Nurse $556,376.60 Registered Nurse $64,370.00 Registered Nurse $64,370.00
Licensed Practical Nurse $58,604.00Licensed Practical Nurse $58,604.00 Licensed Practical Nurse $10,742.00Licensed Practical Nurse $10,742.00
Nursing AssistantNursing Assistant $64,153.32$64,153.32 Nursing Assistant Nursing Assistant $7,462.00$7,462.00
Total CostTotal Cost $679,133.92$679,133.92 Total CostTotal Cost $82, 574.00$82, 574.00
HeartCode BLSHeartCode BLSCost EffectiveCost Effective
Savings $596,559.92Savings $596,559.92Staffing solutionsStaffing solutions
No need to schedule nurses off unitNo need to schedule nurses off unitStaff coverage issuesStaff coverage issuesHours not available for all shiftsHours not available for all shifts
InstructorsInstructorsFacilityFacilityEquipmentEquipment
EvidenceEvidence--based Partnershipbased PartnershipLaerdal Medical Corporation
2007
American Heart Association
Kettering Medical Center
HealthStream2006 Patient
ItIt’’s Not Your Grandmas BLS s Not Your Grandmas BLS AnymoreAnymore
Deployment HeartCode BLSDeployment HeartCode BLSKickKick--off November 2007off November 2007Pilot December 2007Pilot December 2007Go live January 2008 Go live January 2008 Skill LabsSkill Labs
3 campuses3 campuses6 mannequin sets6 mannequin sets6 dedicated computers6 dedicated computers
Labs accessible 24/7Labs accessible 24/7Professional Development staff Professional Development staff available for coachingavailable for coaching
Measures of Success Measures of Success Staff Satisfaction Staff Satisfaction -- BLSBLS
2008200884.2% rated 5/5 (5 Excellent) 84.2% rated 5/5 (5 Excellent) Educational needs met Educational needs met (Survey Monkey, 2008)(Survey Monkey, 2008)
2009 2009 91.2% rated 5/5 (5 Excellent) 91.2% rated 5/5 (5 Excellent) Educational needs met Educational needs met (Survey Monkey, 2009)(Survey Monkey, 2009)
Measures of Success Measures of Success Staff SatisfactionStaff Satisfaction
““Loved the computer feedback!Loved the computer feedback!””
““Love this. It is more realistic.Love this. It is more realistic.””
““I love it this way! I feel I am more prepared should I need to I love it this way! I feel I am more prepared should I need to use my skills.use my skills.””
““This is wonderful. I love the hands on experience and how This is wonderful. I love the hands on experience and how the computer lets you know how you are doing through the the computer lets you know how you are doing through the whole procedure.whole procedure.””
““Great and concise. This ROCKS!Great and concise. This ROCKS!””
““Much better than class. I received precise feedback from the Much better than class. I received precise feedback from the computer.computer.””
““I liked taking the test online and then applying it to the skillI liked taking the test online and then applying it to the skills. s. It made it real.It made it real.””
Measures of Success Measures of Success Clinical OutcomesClinical Outcomes
2007200714% successful resuscitation rate14% successful resuscitation rate
2008200827% successful resuscitation rate 27% successful resuscitation rate
2009200934% successful resuscitation rate34% successful resuscitation rate
““Today, I made a Today, I made a difference!difference!””
Next StepNext StepHeartCode ACLSHeartCode ACLS
ACLS availableACLS available……AWESOMEAWESOME
You get the best efforts from others not by You get the best efforts from others not by lighting a fire beneath them, but by lighting a fire beneath them, but by building a fire within them.building a fire within them.
Deployment HeartCode ACLSDeployment HeartCode ACLS
Pilot 2008Pilot 200850 licenses purchased for trial50 licenses purchased for trial
User GroupUser GroupStaff nurses, medical residents and clinical Staff nurses, medical residents and clinical nurse managersnurse managers
All completed with a passing rateAll completed with a passing rateSatisfaction rate 96% 5/5 met educational Satisfaction rate 96% 5/5 met educational needsneeds
HeartCodeHeartCode ACLS 2009ACLS 2009
567 nurses for recertification of ACLS in 567 nurses for recertification of ACLS in 20092009
Residents and physiciansResidents and physicians
HeartCode ACLS 2009 BenefitsHeartCode ACLS 2009 Benefits
No waiting for available classNo waiting for available classAssignment for new hires instantlyAssignment for new hires instantlyOver 30 days for course completionOver 30 days for course completionTextbook onTextbook on--line and User Guideline and User GuideParticipants can practice at own paceParticipants can practice at own paceCECE’’s upon completions upon completion
Measures of Success Measures of Success Staff Satisfaction Staff Satisfaction -- ACLSACLS
20092009Extremely satisfied 82.3%Extremely satisfied 82.3%
Content met objectivesContent met objectivesContribution to professional effectivenessContribution to professional effectiveness
WhatWhat’’s next? s next? ……High tech, high touchHigh tech, high touch
High Tech High Tech –– High TouchHigh TouchEmbracing technology and patientEmbracing technology and patient--centered, relationshipcentered, relationship--based carebased careNexternship ProgramNexternship ProgramOrientation Orientation –– Collaboration Collaboration
NursingNursingNursing Assistant Nursing Assistant Unit OrientationUnit Orientation
Walking Rounds Walking Rounds –– Unit FocusedUnit FocusedFocused support Focused support –– New GraduateNew GraduateECCO ProgramECCO Program
The New Graduate NurseThe New Graduate Nurse
35% 35% -- 61% of new nursing students 61% of new nursing students leave their place of employment within leave their place of employment within the first year.the first year. (Winter(Winter--Collins & McDaniel, 2000)Collins & McDaniel, 2000)
Supporting Problem Solving SkillsSupporting Problem Solving SkillsSafe EnvironmentSafe Environment
Assessing the problemAssessing the problem
Identifying and analyzing alternativesIdentifying and analyzing alternatives
Making sound decisionsMaking sound decisions
Taking actionTaking action
High Tech High Tech –– High TouchHigh TouchEssentials of Critical Care OrientationEssentials of Critical Care Orientation
64 contact hours64 contact hoursDeveloped by American Association of Critical Developed by American Association of Critical Care NursesCare Nurses25 licenses purchased as trial in 200925 licenses purchased as trial in 2009Students have one year to completeStudents have one year to complete
Hands on with Susan!Hands on with Susan!Integration of simulation with onIntegration of simulation with on--line scenariosline scenarios
High Tech High Tech –– High TouchHigh TouchECCO and BeyondECCO and Beyond
HealthStream courses have been bundled HealthStream courses have been bundled with simulation scenarios to target specific with simulation scenarios to target specific patient populationspatient populations
More handsMore hands--on practice to promote critical on practice to promote critical thinking skillsthinking skills
Integration of simulation with Integration of simulation with multidisciplinary approachmultidisciplinary approach
High Tech High Tech –– High TouchHigh Touch
Susan joins the Air ForceSusan joins the Air Force……
Disaster PreparednessDisaster Preparedness
CalamityvilleCalamityville
High Tech High Tech –– High TouchHigh Touch
Susan goes internationalSusan goes international……
……watch us growwatch us grow
Watch Us GrowWatch Us Grow
Level II NICULevel II NICUTrauma CenterTrauma CenterTransition to Heart TowerTransition to Heart Tower
Six story towerSix story tower23,500 open heart surgeries23,500 open heart surgeries6,000 6,000 cathscaths600 open heart surgeries in 2010600 open heart surgeries in 2010
As We GrowAs We GrowPriorities for 2010 Magnet ViewPriorities for 2010 Magnet View
Transformational LeadershipTransformational Leadership Culture of SafetyCulture of SafetyStaff participation Staff participation –– SNACSNAC
Structural EmpowermentStructural Empowerment Nurse preparation at hireNurse preparation at hireCertificationsCertifications
Exemplary Professional PracticeExemplary Professional Practice Clinical Ladders Clinical Ladders -- MentorsMentorsPI Projects PI Projects –– Simulation ScenariosSimulation ScenariosStaff ResearchStaff Research
New Knowledge, Innovations and New Knowledge, Innovations and ImprovementsImprovements
Level II NICU Level II NICU -- PALSPALSTraumaTraumaEducators Educators -- ResearchResearch
Empirical Quality OutcomesEmpirical Quality Outcomes Resuscitation ratesResuscitation rates
……leaving a legacy for the leaving a legacy for the next generation of Nursesnext generation of Nurses
Sarah age 10Sarah age 10
Malayna age 3Malayna age 3
……for the next generation of for the next generation of patientspatients
Improve the quality of life for the Improve the quality of life for the people in the communities we serve.people in the communities we serve.
Together, with Laerdal, we will save Together, with Laerdal, we will save lives.lives.