Simulation Project:Gap Day

Nursing Orientation: Emergency DepartmentShannon Gaines BSN, MSNc, RN, CPEN

Needs Assessment

Survey Monkey

Change to orientation

New documentation system

Trauma room nursing roles and responsibilities

EPIC Narrator documentation

Learners Identified

Inclusion Criteria: Emergency Department

RN Currently on orientation New graduate Experienced nurse Gap Day 1 complete

Gap DayEmergency Department Nursing specific

Learning DaysStandardize critical needs education for the

orienteeAssess learner needs not met by preceptorDivided into 2 days

Early orientationNear end orientation

Gap Day 1Early orientationReview documentation standardsReview critical care skillsSimple Simulation with airway management

Gap Day 2Late/end orientationSimulation immersiveAssess critical thinkingAssess learner ability “completion” orientation

Pre-work- Day 2Trauma Narrator

PowerPoint

EPIC Sandbox practice documentation

Trauma Activation Roles Job Aid

Learning ObjectivesBy the completion of the simulated experience,

the nursing orientee will be able to:Differentiate the trauma room nursing roles and

responsibilities as per the Trauma Room Roles Job Aid.

Practice trauma documentation standards as per the Trauma Room Roles Job Aid via EPIC Trauma Narrator.

Execute the appropriate nursing actions (skills) for each trauma room nursing role.

Anticipate the role and actions of each trauma nursing role.

(The Children’s Hospital of Philadelphia, 2012)

Simulation DesignRapid Cycle Deliberate Practice

Maximize time in deliberate practicePractice skills learned immediatelyDevelopment of muscle memory

(Hunt, et al., 2013)

15 minutes designated for each “role”5-10 minutes in deliberate practice5 minutes to debrief5-10 minutes to debrief overall simulation

Case Presentation

Critical ActionsBedside Nurse

Remove clothing

Place patient on CR monitor

Set BP to cycle every 3 minutes

Assess patient temperature

Set up and administer push pull fluids when ordered

Obtain IV access

Identify appropriate lab tubes for trauma labs

Appropriately label specimens

Appropriately perform log roll when asked by MD lead

Identify inappropriate sizing of C-collar

Change c-collar to appropriate size

Maintain c-spine immobilization

Performs read-back with medication nurse

Utilize closed loop communication with MD lead and documenting

Critical Actions Start trauma by clicking “start trauma” as patient enters the

room

Enable Dosing weight

Assign provider

Document appropriate primary and secondary survey

Vitals documented every 3 minutes

Verbalize need for further assessment if not available (i.e. vitals, primary, secondary survey, reassessment of abnormalities)

Document when medications are given

Document Intake and Output

Document interventions performed (warmed room, warmed blankets, IV, NG, ETT, etc.)

Document “trauma end”

Document transfer

Documentor

(The Children’s Hospital of Philadelphia, 2014)

Evaluation ToolObserver Checklist

Documenter Checklist

Evaluation Learning Occurred

Difficulty debriefing EPIC Narrator

Timing limitation

Significant manpower needed

Number of participants

Evaluation of Learning Comfort with trauma

room roles

Improved timing of critical needs 1st 5-minute

interventionsMonitorClothing

Trauma managementLog roll IV insertionLabsBolus administration

Review of documentation with EPIC Narrator

Trauma documentation standards Vitals every 3-5 minutes Initial GCS/trauma scores Enabling dosing weight Assigning attending

provider

Participant EvaluationsOverall Positive evaluation

Likhert scale survey given

Survey ResultsParticipants agreed that objectives were metWhat was most helpful in this simulation

“becoming more comfortable with my own knowledge”“Learning roles and practicing skills”“the discussion, and continuing the scenario after

discussing”What would you have done differently?

“a lot at one time”

Future ConsiderationsIs the simulation reproducible?

Number of participantsAncillary staff requirement

2 confederate roles2 observers

Develop two separate simulationsTrauma: Bedside NurseTrauma: Documentation

ReferencesHunt, E., Duval-Arnold, J., Nelson-McMillan, K.,

Bradshaw, J., Diener-West, M., Perretta, J., and Shilkofski, N. (2013). Pediatric resident resuscitation skills improve after “Rapid Cylce Deliberate Practice” training. Resuscitation. 85(7).

The Children’s Hospital of Philadelphia. (2012) Job aid SIM-4001C: Writing educational objectives. Accessed via employee intranet.

The Children’s Hospital of Philadelphia. (2014). Job Aid: Trauma Activation Roles. Accessed via employee intranet.