Transcript of Thomas Dongilli A. T. Director of Operations Peter M. Winter Institute for Simulation, Education and...
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- Thomas Dongilli A. T. Director of Operations Peter M. Winter
Institute for Simulation, Education and Research (WISER)
Administrator Department of Anesthesiology University of Pittsburgh
School of Medicine American Society of Anesthesiologist Endorsed
Simulation Center
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- University of Pittsburgh University of Pittsburgh Medical
Center
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- UPMC21 Hospitals 57,000 Employees SDS and Out Patient Clinics
University of Pittsburgh School of Medicine School of Nursing
School of Pharmacy Undergrad Medical Biology Dental School
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- University of Pittsburgh School of Nursing ISMETT Hospital
Passavant Hospital McKeesport Hospital Childrens Hospital UPMC East
WISER
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- Medicine Medical Students (MS 2-4) Residents Anesthesiology
Emergency Medicine ENT Internal Medicine OB/GYN (course work in
development) Pediatrics Surgery Dental Fellows Critical Care
Pediatric Intensivists Faculty Members and Community Physicians
Anesthesiology Critical Care Medicine Emergency Medicine Nursing
Undergraduate Nursing Students Practicing Nurses Med / Surg ICU OR
Nurse Anesthetists Student Nurse Anesthetists Pharmacy Students
Pharmacists Occupational Therapy Paramedics, EMTs Respiratory
Therapists Other Simulation Centers / Educators Many Others
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- Providing a Consistent Experience Build Base Knowledge
Repetitive Deliberate Practice to Increase Retention Introduce
Clinical Variability Start Psychomotor Skills Development Introduce
Team Concepts
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- Preparing To Begin Real Work Standardizing the Experience
Clinical Supplement + + + Procedural Mastery Continue to build base
knowledge Increase Team Functions
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- Maintenance of Competence Base Knowledge Currency of Knowledge
Therapeutic advances Skills / Procedures Base On Experience ???
Clinical Track Record (Quality Assurance)
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- Why cant we shock someone within 2 minutes of a crisis but the
pit crew can complete all of their tasks within 20 seconds? Are we
not as educated as the pit crew? Are they better at their jobs? The
answer is: They are better organized. They practice their jobs!
They practice as a team!
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- RNs MDs PharmDs RRTs Technicians Support Staff Silos contribute
to medical errors!
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- The IOM defines medical error as the failure to complete a
planned action as intended or the use of a wrong plan to achieve an
aim. Approximately 1.3 Million patients are injured annually in the
United States as a result of a Preventable Medical Errors The
National Coordinating Council for Medication Error Reporting and
Prevention Top 2 causes of preventable medical errors or adverse
events: 1.Equipment Errors. Failure to utilize or malfunction of
equipment 2.Diagnosis Errors. Failure to diagnose or recognize
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- 1999.Between 44,000 and 98,000 Americans die each year in U.S.
hospitals due to preventable medical errors (Institute Of
Medicine)Institute Of Medicine 2004. 195,000 Americans die a year
due to preventable errors (HealthGrades)HealthGrades An estimated
15,000 Medicare patients die each month in part because of care
they received 99,000 patients die as a result of hospital-acquired
infections (HAI) each year (AHRQ, 2009).AHRQ Hospital errors rank
between the fifth and eighth leading cause of death, killing more
Americans than breast cancer and traffic accidents (IOM). Just one
type of errorpreventable adverse drug events causes one out of five
injuries or deaths per year to patients in the hospitals
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- Occurrences per 1000 patients admitted
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- If a 747 jetliner crashed every day, killing all 500 people
aboard, there would be a national uproar over aviation safety and
an all-out mobilization to fix the problem. In the nation's
hospitals, though, about the same number of people die on average
every day from medical "adverse events," many of them preventable
errors such as infections or incorrect medications. USA Today
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- Psychomotor Skills Communications Skills Professionalism Skills
Decision Making Base Knowledge Teamwork Skills
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- Assessment Individual Psychomotor Skills Monitoring and
Intervention Skills Clinical Problem Solving Communication and
Teamwork skills Clinical Reasoning
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- Crisis Team Data
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- Braithwaite et al. Use of medical emergency teams to detect
medical errors. QUAL SAFETY HEALTH CARE, 2004. Activation of
Response Teams
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- Patient Safety Initiatives. Training? Risk Management?
Financial? Competencies? Operational Efficiency? Clinical
Preparedness?
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- Picked 1 topic to reviewMedical Crisis utilization of Rapid
Response Team Training Emphasis on The Team Utilizing highly
trained personnel Bringing critical care to the patient bed side
Promoting early intervention Mock Codes were initially used to
assess the Team and System Responses Initial responders were
unclear of role and treatment protocols Minimal to no training for
the true 1 st Responders (except BLS)
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- Identified Key Areas for Improvement Recognition of Crisis Do
they actually identify a crisis? Initial treatment of patients in
crisis by non ICU / Code Team members What can they do before the
code team arrives?
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- Rationale for Course Development We want to: Enhance critical
thinking and motor skills of initial providers Improve early
problem recognition Eliminate inconsistent initial interventions
Standardize key responses Empower decision making Improve
communication Complement the MET team Assessment of current site
training and policies
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- How many of you are instructors for students? How many clinical
sites do your students rotate through? How many of you work and
rotate units or at clinical sites? Are you / they prepared for an
emergency at each site? What is the correct number to dial for a
code at each site? Where is the Code Cart located? Is there
equipment in my patients room (O2, BVM, etc). What are you expected
to do in the first 5 of a crisis?
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- The First 5 Minutes Course Can be Mobile Sessions can last as
little as 30 minutes Rotate through while on duty Use as
preparation for clinical rotations Curriculum Discuss why
participants are there Statistics about initial responders (local
policies) Carry out scenario focusing on initial assessment and
management Provide comprehensive debriefing session with questions
and answers Provide time to practice skills
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- Simulated Experience Identify a crisis is occurring Assess ABCs
Call for appropriate help Utilize local staff and equipment Work
together as a team Perform key common tasks prior to MET arrival
Package the patient for the MET team
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- ABCs Calling for help Crash cart arrival HOB and Backboard Pad
placement Proper use of AED O 2 and Airway management IV
verification Communication Documentation
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- Greater than 9 minutes to shock patient (Avg.) BVM less than
10% of patients 40% of the participants did not know the correct
number to dial to activate the Rapid Response Team Report was
inconsistent 80% of the nurses did not set the defib to the
appropriate setting (all defibs had AED functionality)
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- Scenario Reviewed Time to practice equipment and skills 2 nd
Scenario run 2 nd Scenario Averages: Less than 1:50 Seconds to
complete key tasks 96% of top 20 tasks completed within time frame
Report standardized Equipment utilized
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- Mandatory training for all non-ICU staff Opposite BLS
recertification Part of initial BLS certification and training day
Roll out program to nurses throughout health system RT and PCT are
also invited to sessions SON Utilization Utilized for students
prior to first clinical Include new equipment, policies
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- Pursue other possibilities for using the initial response
structure: Trauma Patient Entering the Emergency Room When New
Admission Enters Unit Crisis in Radiology ICU Application Continue
to assess actual responses Create a Critical Care adaptation
Include other disciplines Continue movement into outpatient
areas
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