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Practical Simulation: Key Principles & Methodologies:

making the rubber meet the road

by John J. Schaefer, III, MD, Professor Anesthesia and Perioperative MedicineAssistant Dean MUSC College of Medicine, Lewis Blackman Endowed ChairSouth Director: HealthCare Simulation of South Carolinaemail: schaefer@musc.edu

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Charleston, SC and the Medical University of South Carolina

Settled 1670

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Established 1824Colleges Medicine, Nursing, Dentistry, Pharmacy, Health ProfessionsMUSC Medical Center is comprised offour separate hospitals (the University Hospital, the Institute of Psychiatry, the Children's Hospital, and the Ashley River Tower). The Medical Center includes centers for specialized care (Heart Center, Transplantation Center, Hollings Cancer Center, Digestive Diseases Center).

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4Objectives:Practical Simulation Methods in HealthCare EducationPractical Simulation DefinedWhy Practical Simulation is critical to your successThe operational concept to achieve itPractical Simulation Demonstrations across range of Simulation typesTask training: NG tube objective assessment (interactive demo)Task Training: Orthopedic Surgery (video demo)Student run multi-simulator, single instructor interactive demo Individual assessment----Nursing student med administration (video demo)Individual assessment----Pediatric Resident NRP Individual assessment (video demo)Team Training:Team Leader Focus: Pediatric ER emergencies (video demo)Interdisciplinary Focus: SIRE (video demo)Specialty Team Focus: Neonatal LBW Team (video demo)Research using SimulationSummary5Objectives:Practical Simulation Methods in HealthCare EducationPractical Simulation DefinedWhy Practical Simulation is critical to your successThe operational concept to achieve itPractical Simulation Demonstrations across range of Simulation typesTask training: NG tube objective assessment (interactive demo)Task Training: Orthopedic Surgery (video demo)Student run multi-simulator, single instructor interactive demo Individual assessment----Nursing student med administration (video demo)Individual assessment----Pediatric Resident NRP Individual assessment (video demo)Team Training:Team Leader Focus: Pediatric ER emergencies (video demo)Interdisciplinary Focus: SIRE (video demo)Specialty Team Focus: Neonatal LBW Team (video demo)Summary6Practical Simulation Pyramid of SuccessCommunicate ValueEstablish ValueCreate/Deliver Quality CoursesCreate a Functional Center/LabDevelop a Realistic PlanFocus will be on simulation methodology critical to achieving success!What is meant by practical simulation in Healthcare?Simulation as a teaching methodology that takes advantage of simulator tools where diverse and large numbers of Healthcare students and practitioners have individual and group access to training.Healthcare teachers with reasonable training can adopt simulation training methodologies rapidly.The value of using simulation justifies the capital, operating and indirect costs associated with it.

8Objectives:Practical Simulation Methods in HealthCare EducationPractical Simulation DefinedWhy Practical Simulation is critical to your successThe operational concept to achieve itPractical Simulation Demonstrations across range of Simulation typesTask training: NG tube objective assessment (interactive demo)Task Training: Orthopedic Surgery (video demo)Student run multi-simulator, single instructor interactive demo Individual assessment----Nursing student med administration (video demo)Individual assessment----Pediatric Resident NRP Individual assessment (video demo)Team Training:Team Leader Focus: Pediatric ER emergencies (video demo)Interdisciplinary Focus: SIRE (video demo)Specialty Team Focus: Neonatal LBW Team (video demo)Research using SimulationSummary9MUSC Healthcare Simulation Center11,000 sq ft training space, 15 available training rms.Stake holders: All Colleges & Medical CenterOpened June 2008Activities 2008-09:70 course9,000 student encounters6,000 full scale simulations2,000 task trainer simulations70 faculty involved in simulation

Focus will be on simulation methodology critical to achieving success!10Simulation Center Capital Costs Example:Large Center:Size: 11,000 sq ft facilityCapital Costs:Renovation ~ $1,566,353Simulation equip.~ $810,000AV equipment ~ $300,638Computers ~ $206,500Other~ $25,000Total: ~ $2,908,491

Average capital cost / sq. ft ~ $250

11Simulation Center Costs/yr. Examples:Large Center:Staff: 30% Med. Director, 2 Admin., 2 Sim., Spec., 1 ITOperational Costs:Salaries ~ $303,027Rent~ $208,847Other~ $61,250subtotal: ~ $573,124Recapitalization Costs:~$117,250Total Costs per year:~$690,374

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Typical busy weeks schedule

Focus will be on simulation methodology critical to achieving success!13Advocacy vs. Value based funding:Advocacy based funding:The concept seems valuable-- so Ill payGenerates enthusiasm but is harder to translate into $Difficult to sustainFickle/Vulnerable to changeValue based funding:The results of trainingare valuable--- so Ill payThe training cost $ you save us is worth what we pay you--- so Ill payThe malpractice cost $ you save us is worth what we pay you--- so Ill payFocus will be on simulation methodology critical to achieving value!14Value Model (which is the basis of what a stakeholder is paying for):Value from the viewpoint of those funding medical simulation commonly falls into at least four forms:

Utilization:# students trained# courses delivered# faculty involvedMeasured Educational Value:Subjective evaluationsObjective evaluations Peer reviewed publicationsNon-peer reviewed publicationsGrant dollars generatedFinancial Educational Value:Indirect dollar savings (Malpractice Costs)Direct dollar generation or savings (Save direct training dollars)Public Relations Value:RecruitmentReferrals to Health SystemFund RaisersOthers15Communicate Value (to Stakeholders)

16Objectives:Practical Simulation Methods in HealthCare EducationPractical Simulation DefinedWhy Practical Simulation is critical to your successThe operational concept to achieve itPractical Simulation Demonstrations across range of Simulation typesTask training: NG tube objective assessment (interactive demo)Task Training: Orthopedic Surgery (video demo)Student run multi-simulator, single instructor interactive demo Individual assessment----Nursing student med administration (video demo)Individual assessment----Pediatric Resident NRP Individual assessment (video demo)Team Training:Team Leader Focus: Pediatric ER emergencies (video demo)Interdisciplinary Focus: SIRE (video demo)Specialty Team Focus: Neonatal LBW Team (video demo)Research using SimulationSummary17Complexity of operating simulator & TeachingExpert Instructor,Expert Simulator OperatorHigh Costs per studentCompetent Facilitator(runs own simulator)Lower cost per studentStudent self trainingor 1 facilitator with multiple sim. activitiesLow costUtilization of Simulation-based Education MethodsRange of HealthCare Simulation Operational Use:Most Users are here---This is what we have been doing since 2002---We do some of this now too--This is key to what you will see18Simulator predominantly in manual mode or scenario (3G) is modified on the fly

Limited Objective educational outcomes

Utilization is severely limited by limited # of Expert Instructors and Expert simulator operatorsSimulator only running a scenario with a specific set of objectives with grading and feedback

Extensive Objective educational outcomes

Utilization is significantly increased because competent Facilitator training threshold is loweredExpert Curriculum/Scenario, Competent Facilitator ModelPractical SimulationExpert Instructor

Small grp. exercisesExpert Sim. OperatorCurrent Expert Instructor/Sim Operator approach

Competent Facilitator

Competent Facilitator

Competent Facilitator19And in some casesCompetent Supervisor

Student independent learning

Student independent learning

Student independent learning

Student independent learningSimulator only running a scenario with a specific set of objectives with grading and feedback and operated by trainees

Extensive Objective educational outcomes

Utilization is maximized because complexity of operation threshold is lowered to the point that trainees can learn to run a scenario in minutes.Note: until this level is achieved, using simulation requires more Instructors than traditional educational methods though many believe simulation decreases the need.20What does not work well--Manually adjusting the simulator on the fly to create a case that tracks with training objectives can only be done by a highly trained operator (even with a script).

Simultaneous paper and pencil or electronic evaluation with some type of evaluation form while you are also running a simulator (this requires concentration) is generally impractical.

Non-structured Debriefing. While some people have been formally trained as educators, most Healthcare providers that teach are not. 21With manual operation of the simulator, you have to teach a teacher to competently run this GUI with enough expertise to create Human Reactions in real time while watching the trainees:

There are hundreds of possible controls selections and just adjusting vital signs for a modern monitor is tough to do in real time22What does work pretty well--Pre-course participant preparation through studying online curricula based on adult learning principles.With just about any simulation training exercise, the facilitator has immediately available well designed curricula to support standardization (usually web-based) with less time in training of the trainer.The simulation exercise uses a well designed, pre-programmed simulation scenario run by the facilitator (teacher). This scenario incorporates semi-automated evaluation of key educational objectives embedded in the scenario that are automatically flagged for focused feedback specific to the individual or groups performance and additionally supports standardization of the whole evaluation/feedback process.The facilitator then uses this debriefing file as a preliminary educational diagnosis that when coupled with a standardized reflection process leads to a focused, standardized (yet individually specific) learning encounter with the student. 23With a well programmed scenario, a teacher (or student) only has to accurately run this-

Bag-Mask competency skill scenario

LMA skill competency scenario

BP assessment practice skill scenario

Nursing Critical Care Assessment Training scenario

Anesthesia Difficult Airway Management Competency scenario

Nursing Med Surg Training scenario

Trauma Assessment Demo scenarioNOTE:With a scenario, the menu either serves to advance the scenario or document an action that is coupled to an evaluation point. The simulator has multiple sensors that in a scenario do the same thing. THEREFORE the number of actions a facilitator has to perform at any one time is manageable with practice (2-6 practice runs). Also the intuitiveness of running a scenario is enhanced when the menus are well organized and use terminology matched to the teachers that will be running it (i.e. Nursing--- NLN , Anesthesia LMA.24With a well programmed scenario, physiology, pathophysiology, pharmacodynamics, seizures, airway obstruction, etc. are pre-programmed

With selection of Standard induction of general anesthesia, apnea, airway obstruction, hypoxic physiology automatically occurNote:1) In this scenario when the anesthetic is started, 1 action by the facilitator cues complicated physiology that in the manual mode would be very tough to emulate on the fly AND a specific pattern of airway obstruction is triggered25Multimedia can be embedded in a programmed scenario to:Present simulation case stem

Note:1) Embedding this standard info. Into the scenario makes for less stuff needed to support it (paper, electronic files etc) And

2) Less things you have to train a facilitator to do.26Multimedia can be embedded in a programmed scenario to:Diagnostic information: labs, EKGs, X-rays, videosECHO, ultrasounds

Choosing a menu item here returns a set of Physician orders on the monitor

Note:Embedding diagnostic info. Into the scenario can increase the critical fidelity of the training encounter (stuff critical to training/testing clinical judgment).

Embedding also has the benefit of decreasing the work load of setting up/running/training people to use the scenario.27Multimedia can be embedded in a programmed scenario to:Clinical signs & symptoms (as a picture, sound, movie or document that is presented on the monitor) that the actual simulator cant otherwise emulate.

Note:Using embedded/automated multimedia this way is a critical step to addressing the fidelity short comings of existing simulators to flexibly add important clinical signs and symptoms.

Embedding also has the benefit of decreasing the work load of setting up/running/training people to reliably otherwise cue/create clinical signs and symptoms simulators cant do.

This helps to standardize potentially critical elements of high stakes evaluation or research.

This may be a reasonable compromise between the trade-offs of expensive hardware additions to simulators and fidelity.

Currently this allows tremendous flexibility in creating ranges of scenarios to meet a wide array of stake holders training variability.

28Multimedia can be embedded in a programmed scenario to:Standardized debriefing cues during the simulation that automatically appear on the monitor.

Note : these cues can be used in different ways:---cue timing ---provide real time feedback of correct & incorrect performance issues

THIS helps to support standardization which a) improves the quality and reproducibility of a learning objective and b) lowers the training threshold of the facilitator (there are less things to remember or script).29Multimedia can be embedded in a programmed scenario to:Scenario support info.: i.e. equipment list, equipment layout & QA, instructions, etc.

-Embedding has the benefit of decreasing the work load of setting up/running/training people to use the scenario.

-Doing it this way decreases Admin. Support and Sim specialists workload.

-All the above impacts scenario quality assurance.

-Simplifies the process of collaboration.

-Can print this out from the Monitor for a hard copy.

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Nursing Aspiration Prevention & RxSemi-Automated, Standardized Guide for Diagnostic Educational Objectives based Reflection

31Well designed/programmed scenarios that are simple to run coupled withSemi-Automated Objective Driven Reflection Process

Ford assembly line was the standardization key to practical automobile production,

Educational objective based scenario design with semi-automated driven reflection process has been our key to mass, practical healthcare simulation

With this approach we have taken groups that had little experience and now do thousands of simulations/year

The future focus is further automation of the data to more easily create/communicate value statements32Objectives:Practical Simulation Methods in HealthCare EducationPractical Simulation DefinedWhy Practical Simulation is critical to your successThe operational concept to achieve itPractical Simulation Demonstrations across range of Simulation typesTask training: NG tube objective assessment (interactive demo)Task Training: Orthopedic Surgery (video demo)Student run multi-simulator, single instructor interactive demo Individual assessment----Nursing student med administration (video demo)Individual assessment----Pediatric Resident NRP Individual assessment (video demo)Team Training:Team Leader Focus: Pediatric ER emergencies (video demo)Interdisciplinary Focus: SIRE (video demo)Specialty Team Focus: Neonatal LBW Team (video demo)Research using SimulationSummary33Task training: NG tube objective assessment (interactive demo)

34Good Theater does not equal Learning!

=35Task training: NG tube objective assessment (interactive demo)

36Task training: NG tube objective assessment (interactive demo)Key Points to observe:Using SimMan or SimBaby or VitalSim Advanced software with a dumb task trainer to enhance simulationSpecific educational objectives drivenSimplified menusUse of multimedia to support standardizationDebriefing log documents performance of specific educational objectivesPerformance is automatically scored!37

Lets do it---Need a volunteer to run scenario (familiar with a nasogastric tube)Minimal experience with SimManNOTE: I will be the 38Vital Signs TrainingCompetent Supervisor

Student independent learning

Student independent learning

Student independent learning

Student independent learning39Vital Signs TrainingALS (Vital Sim Advanced) & SimMan Simulators1 student runs simulator, 1 student measures RR, 1 student measures HR, 1 student measures BP then switch & practice again, & again---etc.Call facilitator for help as needed, when confident take summative version.40Student run multi-simulator, single instructor interactive demoCompetent Supervisor

Student independent learning

Student independent learning

Student independent learning

Student independent learningSimulator only running a scenario with a specific set of objectives with grading and feedback and operated by trainees

Extensive Objective educational outcomes

Utilization is maximized because complexity of operation threshold is lowered to the point that trainees can learn to run a scenario in minutes.Note: until this level is achieved, using simulation requires more Instructors than traditional educational methods though many believe simulation decreases the need.

41Student run multi-simulator, single instructor interactive demoKey PointsSpecific educational objectives drivenSimplified menusUse of multimedia to support standardizationPerformance is automatically scored and shows on monitor!Debriefing log documents performance of specific educational objectives42

Lets do it---Need 8 volunteers to run scenario (familiar with measuring HR, BP, RR)Minimal experience with SimMan

43Practical Model used in following examples:Expert Curriculum/Scenario, Competent Facilitator ModelSimulator only running a scenario with a specific set of objectives with grading and feedback

Extensive Objective educational outcomes

Utilization is significantly increased because competent Facilitator training threshold is lowered

Competent Facilitator44Team Leader Focus: Pediatric ER emergencies (video demo)

Video: Peds Resc Demo2.wmv45Individual assessment----Nursing student med administration (video demo)

Video: Nursing Med Admin Demo.wmv46Interdisciplinary Focus: SIRE (video demo)

Video: SIRE Demo 2.wmv47Research using Simulation

Video: ACLS IPhone App Demo.wmv48Individual assessment----Pediatric Resident NRP Individual assessment (video demo)

Video: Peds Resc Demo2.wmv49Specialty Team Focus: Neonatal LBW Team (video demo)

Video: Golden Hr Demo.wmv50Task Training: Orthopedic Surgery (video demo)

Video: Sawbones Demo.wmv51Objectives:Practical Simulation Methods in HealthCare EducationPractical Simulation DefinedWhy Practical Simulation is critical to your successThe operational concept to achieve itPractical Simulation Demonstrations across range of Simulation typesTask training: NG tube objective assessment (interactive demo)Task Training: Orthopedic Surgery (video demo)Student run multi-simulator, single instructor interactive demo Individual assessment----Nursing student med administration (video demo)Individual assessment----Pediatric Resident NRP Individual assessment (video demo)Team Training:Team Leader Focus: Pediatric ER emergencies (video demo)Interdisciplinary Focus: SIRE (video demo)Specialty Team Focus: Neonatal LBW Team (video demo)Research using SimulationSummary52Complexity of operating simulator & TeachingExpert Instructor,Expert Simulator OperatorHigh Costs per studentCompetent Facilitator(runs own simulator)Lower cost per studentStudent self trainingor 1 facilitator with multiple sim. activitiesLow costUtilization of Simulation-based Education MethodsRange of HealthCare Simulation Operational Use:Focus on the methods to work in towards this quadrantThis is key to what you will see53Specific Focus Areas:Focus on complex scenarios that run simplyTake advantage of multimedia fx. to support simplification & standardizationWhatever grading paradigm you prefer, maximize the opportunity for simplification & value through automationFocus on designing intuitive menusIts all about removing barriers & creating value statements at the individual & stakeholder level

Hope this was inspiring---

55Chart10.27169590640.68233618230.9682539683

Session% Tasks Completed SuccessfullyResults

Sign InCritical Care Crisis Team Leadership TrainingSesion TraineesFisher, MarilynLane, MargiWilliams, JackWagener, MelindaKumar, RaniJackson, JoyceAllen, GideonKennedy, KristyDavis, EdTurley, MarkWhite, Michaelschuchert, raniKurdi, Mostafa

StartCONDITION A AND C RESPONSE TRAINING SCORESHEETScenario #2Percentages:Date60 seconds28%Time3 minutes37%Simulator5 minutes17%LocationAverage:27%PreceptorTape NumberScenario OutcomeDeathNamesAirwayWhite, MichaelAirway AssistantDavis, EdFloor RNKennedy, KristyICU RN (Cart)Fisher, MarilynTeam LeaderKumar, RaniRecorder ICURNWagener, MelindaProcedure MDJackson, JoyceChest compressionsWilliams, JackAideAllen, GideonCommentsSave to:W:\XXVII. CCM\Crisis Team Session Spreadsheets

60 Sec60 seconds (1)StationTeam MemberItemsid_taskCTTDCAOAirwayWhite, MichaelIdentify self1NCheck Airway2NSaveOpen airway < 60 seconds3NSaveCheck Breathing4NSaveAssist ventilation < 60 seconds5NAirway AssistantDavis, EdIdentify self6NSet up oxygen7NSaveSet up oxygen bag8NSaveSet up mask9YSaveFloor RNKennedy, KristyIdentify self10YCheck pulse < 30 seconds11YSavePlace defib pads < 60 seconds12NSaveCheck IV Access < 60 seconds13YICU RNFisher, MarilynIdentify self14NTeam LeaderKumar, RaniIdentify self15NAssign Roles16NRecorder ICU RNWagener, MelindaIdentify self17NHand ID stickers to responders18NProcedure MDJackson, JoyceIdentify self19YCheck Pulse20YAssist CPR21NChest CompressionsWilliams, JackIdentify self22NInitiate chest compressions23NAssess adequacy of compressions24N/AAssess pulse as requested25YAideAllen, GideonIdentify self26N60 second ct positives:760 second total spots2528%

Completed Within TimeTask DifficultyContributesto adverseeventSaveSaveSaveSaveSaveSaveSaveSaveSave

3 Min3 minutes (1)StationTeam MemberItemsid_taskCTTDCAOAirway AssistantDavis, EdSet up pulse oxYSet up oxygenNFloor RNKennedy, KristyCheck BP < 2 minutesYCheck pulse ox < 3 minutesYICU RNFisher, MarilynHand ID stickers to recording RNNPrepare medsNDeliver medsNRun Defibulator/pacerYTeam LeaderKumar, RaniAssess dataYDefinitive intervention < 3 minutesNSaveRecorder ICU RNWagener, MelindaRecord team membersNHand ID stickers to respondersNObtain patient chart < 3 minutesNProcedure MDJackson, JoyceObtain IV accessN/AObtain ABGN/AAssist CPRNChest CompressionsWilliams, JackPlace back boardNInitiate chest compressionsNAssess adequacy of compressionsNAssess pulse as requestedYAideAllen, GideonGet supplies as neededY3 minute ct positives:73 minute total spots1937%

Completed Within TimeTask DifficultyContributesto adverseeventSave

5 Min5 minutes (1)StationTeam MemberItemsid_taskCTTDCAOAirwayWhite, MichaelIntubateNAirway AssistantDavis, EdSet up suction (tonsil, trach)NAssist intubationNFloor RNKennedy, KristyObtain IV access < 5 minutesYPush medicationsYICU RNFisher, MarilynCrowd controlNTeam LeaderKumar, RaniTherapeutic decisionsYAssess complete tasksNTriage decisionsN/AAssess readiness for transportN/ATransportN/ARecorder ICU RNWagener, MelindaObtain allergies < 5 minutesNObtain medications < 5 minutesNObtain past medical HX < 5 minutesNObtain last meal < 5 minutesNObtain event < 5 minutesNRecords labs sentN/AObtain lab resultsNProcedure MDJackson, JoycePerform chest tubeN/APerform pericardiocentesisN/AChest CompressionsWilliams, JackAssess pulseN/AInitiate chest compressionsNAssess adequacy of compressionsNAssess pulse as requestedNAideAllen, GideonGet supplies as neededN5 minute ct positives:35 minute total spots1817%

Completed Within TimeTask DifficultyContributesto adverseevent

SavesSaves (1)Itemsid_taskCTWho Saved?Whose responsibilityCheck Airway2060 secOpen airway < 60 seconds30Check Breathing40Assist ventilation < 60 seconds50Set up oxygen70Set up oxygen bag80Set up mask90Check pulse < 30 seconds110Place defib pads < 60 seconds120Definitive intervention < 3 minutes03 Min

Completed Within Time60 sec3 Min

Start (2)CONDITION A AND C RESPONSE TRAINING SCORESHEET (2)Scenario #5Percentages:Date60 seconds65%Time3 minutes78%Simulator5 minutes62%LocationAverage:68%PreceptorTape NumberScenario OutcomeSurviveNamesAirwayKumar, RaniAirway AssistantTurley, MarkFloor RNFisher, MarilynICU RN (Cart)Williams, JackTeam LeaderWhite, MichaelRecorder ICURNJackson, JoyceProcedure MDschuchert, raniChest compressionsAllen, GideonAideWagener, MelindaCommentsSave to:W:\XXVII. CCM\Crisis Team Session Spreadsheets

60 Sec (2)60 seconds (2)StationTeam MemberItemsid_taskCTTDCAOAirwayKumar, RaniIdentify self1YCheck Airway2YSaveOpen airway < 60 seconds3YSaveCheck Breathing4YSaveAssist ventilation < 60 seconds5YAirway AssistantTurley, MarkIdentify self6YSet up oxygen7NSaveSet up oxygen bag8YSaveSet up mask9YSaveFloor RNFisher, MarilynIdentify self10NCheck pulse < 30 seconds11YSavePlace defib pads < 60 seconds12NSaveCheck IV Access < 60 seconds13YICU RNWilliams, JackIdentify self14NTeam LeaderWhite, MichaelIdentify self15NAssign Roles16YRecorder ICU RNJackson, JoyceIdentify self17YHand ID stickers to responders18NProcedure MDschuchert, raniIdentify self19NCheck Pulse20YAssist CPR21YChest CompressionsAllen, GideonIdentify self22NInitiate chest compressions23YAssess adequacy of compressions24YAssess pulse as requested25YAideWagener, MelindaIdentify self26N60 second ct positives:1760 second total spots2665%

Completed Within TimeTask DifficultyContributesto adverseeventSaveSaveSaveSaveSaveSaveSaveSaveSave

3 Min (2)3 minutes (2)StationTeam MemberItemsid_taskCTTDCAOAirway AssistantTurley, MarkSet up pulse oxYSet up oxygenNFloor RNFisher, MarilynCheck BP < 2 minutesYCheck pulse ox < 3 minutesYICU RNWilliams, JackHand ID stickers to recording RNNPrepare medsN/ADeliver medsN/ARun Defibulator/pacerYTeam LeaderWhite, MichaelAssess dataYDefinitive intervention < 3 minutesYSaveRecorder ICU RNJackson, JoyceRecord team membersYHand ID stickers to respondersNObtain patient chart < 3 minutesYProcedure MDschuchert, raniObtain IV accessYObtain ABGN/AAssist CPRYChest CompressionsAllen, GideonPlace back boardNInitiate chest compressionsYAssess adequacy of compressionsYAssess pulse as requestedYAideWagener, MelindaGet supplies as neededY3 minute ct positives:143 minute total spots1878%

Completed Within TimeTask DifficultyContributesto adverseeventSave

5 Min (2)5 minutes (2)StationTeam MemberItemsid_taskCTTDCAOAirwayKumar, RaniIntubateYAirway AssistantTurley, MarkSet up suction (tonsil, trach)NAssist intubationYFloor RNFisher, MarilynObtain IV access < 5 minutesN/APush medicationsN/AICU RNWilliams, JackCrowd controlNTeam LeaderWhite, MichaelTherapeutic decisionsYAssess complete tasksYTriage decisionsNAssess readiness for transportNTransportNRecorder ICU RNJackson, JoyceObtain allergies < 5 minutesN/AObtain medications < 5 minutesN/AObtain past medical HX < 5 minutesN/AObtain last meal < 5 minutesN/AObtain event < 5 minutesYRecords labs sentN/AObtain lab resultsN/AProcedure MDschuchert, raniPerform chest tubeN/APerform pericardiocentesisN/AChest CompressionsAllen, GideonAssess pulseYInitiate chest compressionsN/AAssess adequacy of compressionsN/AAssess pulse as requestedYAideWagener, MelindaGet supplies as neededY5 minute ct positives:85 minute total spots1362%

Completed Within TimeTask DifficultyContributesto adverseevent

Saves (2)Saves (2)Itemsid_taskCTWho Saved?Whose responsibilityCheck Airway2060 secOpen airway < 60 seconds30Check Breathing40Assist ventilation < 60 seconds50Set up oxygen70Set up oxygen bag80Set up mask90Check pulse < 30 seconds110Place defib pads < 60 seconds120Definitive intervention < 3 minutes03 Min

Completed Within Time60 sec3 Min

Start (3)CONDITION A AND C RESPONSE TRAINING SCORESHEET ()Scenario #3Percentages:Date60 seconds100%Time3 minutes100%Simulator5 minutes90%LocationAverage:97%PreceptorTape NumberScenario OutcomeSurviveNamesAirwayTurley, MarkAirway AssistantDavis, EdFloor RNAllen, GideonICU RN (Cart)Kennedy, KristyTeam Leaderschuchert, raniRecorder ICURNLane, MargiProcedure MDWilliams, JackChest compressionsFisher, MarilynAideJackson, JoyceCommentsSave to:W:\XXVII. CCM\Crisis Team Session Spreadsheets

60 Sec (3)60 seconds (3)StationTeam MemberItemsid_taskCTTDCAOAirwayTurley, MarkIdentify self1YCheck Airway2YSaveOpen airway < 60 seconds3YSaveCheck Breathing4YSaveAssist ventilation < 60 seconds5YAirway AssistantDavis, EdIdentify self6YSet up oxygen7YSaveSet up oxygen bag8YSaveSet up mask9YSaveFloor RNAllen, GideonIdentify self10YCheck pulse < 30 seconds11YSavePlace defib pads < 60 seconds12YSaveCheck IV Access < 60 seconds13YICU RNKennedy, KristyIdentify self14YTeam Leaderschuchert, raniIdentify self15YAssign Roles16YRecorder ICU RNLane, MargiIdentify self17YHand ID stickers to responders18N/AProcedure MDWilliams, JackIdentify self19YCheck Pulse20YAssist CPR21N/AChest CompressionsFisher, MarilynIdentify self22YInitiate chest compressions23N/AAssess adequacy of compressions24N/AAssess pulse as requested25YAideJackson, JoyceIdentify self26Y60 second ct positives:2260 second total spots22100%

Completed Within TimeTask DifficultyContributesto adverseeventSaveSaveSaveSaveSaveSaveSaveSaveSave

3 Min (3)3 minutes (3)StationTeam MemberItemsid_taskCTTDCAOAirway AssistantDavis, EdSet up pulse oxYSet up oxygenYFloor RNAllen, GideonCheck BP < 2 minutesYCheck pulse ox < 3 minutesYICU RNKennedy, KristyHand ID stickers to recording RNYPrepare medsYDeliver medsYRun Defibulator/pacerYTeam Leaderschuchert, raniAssess dataYDefinitive intervention < 3 minutesYSaveRecorder ICU RNLane, MargiRecord team membersYHand ID stickers to respondersYObtain patient chart < 3 minutesYProcedure MDWilliams, JackObtain IV accessYObtain ABGN/AAssist CPRN/AChest CompressionsFisher, MarilynPlace back boardN/AInitiate chest compressionsN/AAssess adequacy of compressionsN/AAssess pulse as requestedYAideJackson, JoyceGet supplies as neededY3 minute ct positives:163 minute total spots16100%

Completed Within TimeTask DifficultyContributesto adverseeventSave

5 Min (3)5 minutes (3)StationTeam MemberItemsid_taskCTTDCAOAirwayTurley, MarkIntubateYAirway AssistantDavis, EdSet up suction (tonsil, trach)YAssist intubationYFloor RNAllen, GideonObtain IV access < 5 minutesYPush medicationsYICU RNKennedy, KristyCrowd controlYTeam Leaderschuchert, raniTherapeutic decisionsYAssess complete tasksYTriage decisionsYAssess readiness for transportYTransportYRecorder ICU RNLane, MargiObtain allergies < 5 minutesYObtain medications < 5 minutesNObtain past medical HX < 5 minutesYObtain last meal < 5 minutesNObtain event < 5 minutesYRecords labs sentYObtain lab resultsYProcedure MDWilliams, JackPerform chest tubeN/APerform pericardiocentesisN/AChest CompressionsFisher, MarilynAssess pulseYInitiate chest compressionsN/AAssess adequacy of compressionsN/AAssess pulse as requestedYAideJackson, JoyceGet supplies as neededY5 minute ct positives:195 minute total spots2190%

Completed Within TimeTask DifficultyContributesto adverseevent

Saves (3)Saves (3)Itemsid_taskCTWho Saved?Whose responsibilityCheck Airway2060 secOpen airway < 60 seconds30Check Breathing40Assist ventilation < 60 seconds50Set up oxygen70Set up oxygen bag80Set up mask90Check pulse < 30 seconds110Place defib pads < 60 seconds120Definitive intervention < 3 minutes03 Min

Completed Within Time60 sec3 Min

TOTALSTOTALS127%268%397%

TOTALS

Session% Tasks Completed SuccessfullyResults

Lists and labelsThis sheet is protectedCompleted TaskYScenariosBig name listAllen, GideonNNameInterventionCain, MicheleN/A111. Acute MIChest Pain TeamChavko, Robert222. V-TachCardiovertDavis, EdTask DifficultyRoutine333. Morphine O.D.NarcanFisher, MarilynDifficult444. StrokeStroke TeamJackson, JoyceImpossible555. V-FibDefibrillateKennedy, KristyKim, LoriContributes to Adverse EventYesKurdi, MostafaNoLane, MargiPrevents critical incidentMarsico-Foley, MaryLynnPrevents adverse outcomeSalopek, RuthTowers, AdeleScenario outcomeDeathWagener, MelindaCritical incident, surviveWalsh, BrianSurviveWilliams, JackRolesAirwayAirway AssistantFloor RNICU RNTeam LeaderRecorder ICU RNProcedure MDChest CompressionsAidePreceptorsMike DevitaJohn SchaeferTape Numbers12345678910