Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL Center

SCENARIO OVERVIEW

ESTIMATED PRE-SCENARIO TIME: 10 MINUTESESTIMATED SCENARIO TIME: 20 MINUTES DEBRIEFING/GUIDED REFLECTION TIME: 30 MINUTES

TARGET GROUPS: ALL HEALTH CARE PROFESSIONALS (Nursing, Respiratory Care)

BRIEF SUMMARY:

This case will presents a patient who has been admitted to a rehabilitation care facility for strengthening, due to recent increases in weakness and decreased ADLʼs. The patient will start to experience orthopnea and dyspnea while being treated at this facility. The student(s) will be expected to perform a cardiac and pulmonary assessment, evaluate lab data, recognize lack of response to treatment, communicate findings to the primary care provider, and provide proper management and care including coordinating transport of the patient to an emergency department.

LEARNING OBJECTIVES

GENERAL:

Identifies the primary nursing diagnosisImplements patient safety measuresIdentifies relevant patient history informationExplains physical assessment findings and diagnostics related to patient conditionImplements clinician orders appropriatelyDemonstrates therapeutic and confidential communicationDemonstrates direct and accurate communication with multidisciplinary team membersimplements nursing interventions based on patient care needsPrioritizes nursing interventionsIdentifies indications, contraindications and potential adverse effects of prescribed medications.Demonstrates correct medication administration

SCENARIO SPECIFIC:

Implements a focused cardiac and respiratory assessmentExplains clinical findings and critical lab valuesRecognizes the need for patient transfer to an emergency department setting and obtains orders for transfer.Demonstrates appropriate nursing intervention in a patient with congestive heart failureCompletes necessary paperwork and communication for transition of Care

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EquipmentUniversal precaution equipmentHand SanitizerStethoscopeBlood Pressure CuffSpo2 Monitor with probeThermometerPatient Identification BandOxygen Supply SourceManual Resuscitation Device/BVMOxygen Delivery DevicesEKG Monitor and ElectrodesTapeNormal Saline, IV, IV PumpMoulage Supplies (creams, sponge,cup)Urine Catheter with 80ml Urine (yellow)General Medication Administration SuppliesCPAP EquipmentAllergy Bracelet

Equipment Checklist

SIMS MEDICAL CENTER

Medications and FluidsLasix IV

Nitroglycerin SL Tabs

Morphine IV

Documentation Forms

Physician OrdersData Collection Forms

Diagnostics Available

BNP,CMP, CBC, CPK-MB, Troponin - I, Pre-albumin

CXR PA/LAT

EKG

PREPARATION OF THE SIMULATOR

NUMBER OF PARTICIPANTS

Student Roles:

Instructorʼs Roles:Evaluator and Primary Care Provider available by phone

Two (2) NursesOne (1) Relative - wifeOne (1) Respiratory Care provider

Medical - Rehabilitation UnitPlace in semi-fowlerʼs position in hospital bedApply compression stocking with memory foam to simulate lower extremity edemaDress simulator in patient gown Insert Foley catheter with 80ml yellow urineInsert IV angio with J-Loopapply oxygen 4L/min per nasal cannulaSecure ID Band with patientʼs name, DOB and MR#Chart Prep with H&P, Admission Note, Discharge Summary, Med Reconciliation Form

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

PATIENT DATA:

SIMS MEDICAL CENTER

REPORT TO STUDENTS

ADDITIONAL INFORMATION & MEDICAL HISTORY

TIME: 15:00Peter Stevyanovich is a 71 year old male patient who was admitted to the acute rehabilitation unit three days ago after being transferred from a local hospital with a diagnosis of Acute Decompensated Heart Failure. Peter experienced multiple setbacks during his hospitalization and he has become progressively weakened. His care team recommended transfer to the rehabilitation unit to increase his endurance, improve his ability to perform ADLʼs, reduce his home oxygen usage dependency and return home with the ability to care for himself with limited assistance. Last night, Peter began with complaints of shortness of breath while at rest. The nurse caring for him noticed slight increase in pedal edema, but was unable to weigh Peter due to his fatigue. She contacted his PCP, who then ordered labs, oxygen PRN, and increased his lasix by 10mg BID and scheduled a follow up in two days. Peter remained restless through the night and showed no improvement throughout the day. Upon checking on the patient, the covering nurse found Peter with decreased oxygen saturation at 90% and increased work of breathing. She increased his oxygen level to 4LPM and contacted his PCP. She report to you that she is still waiting for updated labs and a call back from Peterʼs PCP.

CLINICAL SIGNS IMMEDIATELY AVAILABLE

- Restless and appearing uncomfortable- Minor Confusion

MEDICAL RECORD #:PAST MEDICAL HISTORY

RECENT MEDICAL HISTORY:

Male - Age 71 YearsWeight 90 kgs Height 72 inches

DATE OF BIRTH: 06/10/1941

98126534

Mr. Stevanovich has had hypertension for the last ten years. and was diagnosed with atrial fib and congestive heart failure five years ago. He has hyperlipidemia. He had been smoking one pack per day for twenty years but quit four years ago. he is a social drinker only. He is current with his vaccinations and has received his annual flu vaccine. He retired six years ago as a foreman and lives with his wife. He has two grown children who are very supportive to their parents.

Mr. Stevyanovich was admitted to a local hospital due to rapid weight gain and CHF exacerbation. He had been increasingly lethargic and was unable to conduct any adlʼs and began with increased respiratory difficulty. He was released to the rehabilitation unit after a 7 day admission. He is hopeful to regain his strength and return home.

ALLERGIES: Inapsine

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL CENTER

INITIAL STATE (START)

Blood Pressure: 184/88Heart Rate: 110Respiratory Rate 36SPO2: 85% on 4 lpm N/CTemperature 98.8 F

After 5 Minutes

Increase Blood Pressure to: 220/102Increase HR to: 138Decrease SPO2 to 78%(Increased vital sign due to further decompensation)

If care is not being effectively delivered after 10 minutes:

If care is progressing effectively after 10 minutes:

BP to 180/82HR to 118RR Remains 30sp02 to 88%

Increase Blood Pressure to: 260/120Increase Heart Rate to: 150Increase Respiratory Rate to: 44Decrease spo2 to 65%IDecreased LOC

Decrease Blood Pressure to: 162/80Decrease Heart Rate to: 110Decrease Respiratory Rate to: 26with CPAP

If the effectiveness of delivery of care improves:Move Back to Green Box

If care is not being effectively delivered after 15 minutes:

Increase Blood Pressure to: 80/40Increase Heart Rate to: 180Increase Respiratory Rate to: 4unresponsive

If Care is Progressing effectively after 15 Minutes, Decrease vital signs to:

At 30 Minutes, if scenario is not successfully completed, please end scenario and move to debriefing

scenario is successfully when patient is transferred or 30 minutes has elapsed, please end scenario and move to debriefing

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

INITIAL VITAL SIGNS

BP: 184/80HR: 110RR: 36SPO2: 85% (on 4lpm n/c)TEMP: 98.9 F

PERRLs3 GallopLung sounds with crackles throughout bilaterally

Patientʼs wife will try to answer every question for patient even if not asked to.

- Wash Hands- Universal Precautions- Introduce Self- Identify the Patient- Obtains vital signs - Obtains Spo2- Auscultates heart and

lungs- Assess IV site- Evaluate Urine output- Evaluate Lab Data

Patient:“ I am very tired and am having such as hard time breathing”

Patientʼs Wife:“ Last time Peter received Lasix the nurse had to empty the urine bag often..Now he has not gone at all?”

BP: 220/102HR: 138RR: 36SPO2: 78% (on 4lpm n/c)TEMP: 98.9 F

(Increased vital signs due to further decompensation)

Vocal Sound:

“ I donʼt feel any better!”

PT becoming more diaphoretic, slight cyanosis present, pt becomes more agitated.

- Communicate findings directly to PCP

- Receive orders, repeat back

- explain lab values and medications to patient

- request respiratory care provider for assistance

- properly administer one SL NTG

- properly administer 80mg Lasix IV & Morphine 4mg IV

Patientʼs wife:

“ Peter doesnʼt seem right!! he is really short of breath and I havenʼt seem him like this in a long time! please help him!

If treatment is not progressing effectively after 10 minutes, change Vital Signs to:BP: 260/120HR:150RR 44spo2 to 65%decreased loc

Patient will become more less responsive, with increased work of breathing, increased cyanosis and diaphoresis.

- Recognizes Respiratory Distress

- Begins treatment plan listed above

Patientʼs Wife:“ it has been eight hours since the last nurse gave Peter any medicine, Peter has not urinated as much as he usually does and I think the doctor wanted to know”

If students successfully deliver care or turn around errors/delays change vitals signs to:

BP: 180/82HR: 118RR 30spo2 to 88%

Pt become less short of breath with treatment, become calmer and less agitated with increased LOC.

- Documents findings and treatments

- Communicates therapy and treatments to the patient and their family (throughout scenario)

- Communicates findings and needs with fellow health care providers caring for the patient

- Continues to monitor patients vital signs

Patientʼs Wife:

Do you think he is doing any better? Does he need to go the ER?

0 to

5 M

INU

TES

5 to

10 M

INU

TES

10 to

15

MIN

UTE

S15

to 2

0 M

INU

TES

TIM

E VITAL SIGNS(MONITOR SETTINGS)

PATIENT/SIMULATORACTIONS

SIMS MEDICAL CENTER

STUDENT INTERVENTIONS

CUES/PROMPTS

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

If students continue to successfully deliver care or turn around errors/delays change vitals signs to:

BP: 162/82HR: 110RR 26 with CPAPspo2 to 95%

decreased diaphoresisdecreased cyanosisimproved vital signs

- Evaluate Vital Signs- Obtains vital signs - Auscultates lungs- Evaluates Urine output- communicate

therapeutically with patient and family

- Contact PCP for transport request

- Begin transfer paperwork

Patient:“ I am starting to feel a little better”

Pt more alert and occasionally says short sentences

If treatment is not progressing effectively after 20 minutes, change Vital Signs to:BP: 80/40HR:180RR 4spo2 to UTOPt becomes unresponsive

patients eyeʼs closeCyanosis increasesvitals signs decreaserespiratory failure signs and symptoms become more prevalent.

- Recognize Respiratory Failure

- Begin Respiratory Ventilations via BVM

- Request Assistance- Begin Proper

Treatment therapies- Contact PCP

requesting transfer- Call 911

Patientʼs Wife:

“ what is wrong? Why is he not responding to me?? why arenʼt you helping him?? He looks really bad!!!

Help!!! Help!!!

If students successfully deliver care or turn around errors/delays change vitals signs to:

BP: 162/82HR: 110RR 26 with CPAPspo2 at 95-97%

Pt asking when he will be going to the hospital and when can he take the mask off his face.

- Reassess patientʼs vital signs

- Complete transfer paperwork

- contact receiving facility

- communicate patient information to EMS.

Patientʼs Wife:

When is he being transferred to the hospital?

How long will he be there?

Do they know about the changes Dr. Casey made?

SCENARIOHASENDED

20 to

25

MIN

UTE

S20

to 2

5 M

INU

TES

25 to

30

MIN

UTE

S30

MIN

UTE

STI

ME VITAL SIGNS

(MONITOR SETTINGS)PATIENT/SIMULATOR

ACTIONS

SIMS MEDICAL CENTER

STUDENT INTERVENTIONS CUES/PROMPTS

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

PROPOSED CORRECT TREATMENT (OUTLINE)

SIMS MEDICAL CENTER

Wash HandsMaintains Universal PrecautionsIntroduce SelfIdentify the Patient ( Minimum two (2) Patient identifiers)Maintains Patient Privacy (Pull Curtain if Applicable)Auscultate Heart and Lung SoundsObtains Blood PressureObtains Pulse RateObtains Respiratory RateObtains Oxygen Saturation Level (SPO2)Obtains TemperatureAssess IV SiteEvaluate urine outputEvaluate Lab DataRecognizes Respiratory FailureCommunicates findings directly to PCPreceives orders, repeats backExplain lab values and medication to patientRequests assistance from Respiratory care therapyProperly administer Nitroglycerin using the “5 Rights”Properly administer Lasix IV using the “5 Rights”Properly administer Morphine IV using the “5 Rights”Assist Respiratory Care with placement of CPAPEvaluates vital signsEvaluate urine outputAuscultate lungsCommunicate therapeutically with patient and familyCommunicates findings and needs with fellow health care providers caring for the patientRequest approval for transport to Emergency Department for patientCompletes all necessary transfer paperworkContacts receiving facility and gives report about patient

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL CENTER

COMMUNICATION

Actor who should respond

Question by Student Response

Patient What is your Name? Huh??? What did you say??? (Hearing impaired) - Delay true answer

Patient How are you feeling? Tired, a little short of breath

Patient Have you been moving around today? A little, Iʼm Tired and short of breath

Wife How has Peterʼs weight been? He has really been retaining fluid and he had a six pound weight gain in a two day period this week.

Wife Did Peter get his flu vaccination this year? Yes he did. He has been getting one since he quit smoking 10 years ago and decided he wanted to be healthier.

Patient What is your pain level? (Pain Scale) Iʼm just sore from being in the same position for a long time, I need to move but i havenʼt been able to.

Wife Has he ever been intubated before? Yes, but he doesnʼt want to ever have that happen again, he even filled out paperwork for that.

Patient After positioning, how do you feel now? A little better

The following communication suggestions for the patient simulator operator and actors are meant to assist with the flow of the scenario. Please utilize these with open-minded ability to communicate with the students outside this list as necessary to keep the plausibility of the scenario intact:

SUGGESTED COMMUNICATIONS

Patient/Family Questions of Students

Patient Patientʼs Wife

Who are You? Why are you in my room? Whatʼs your name? Who are you? will you be taking care of Peter?

What did you say?? (Displaying hearing issues) When will the doctor come in?

Whereʼs my nurse? Are you my nurse? - Same with MD? When will he start to feel better??

I would like a drink of water, Can i have one? What was that medication you gave Peter?

When will I not need this mask? When can Peter go home?

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL CENTER

DEBRIEFING/GUIDED REFLECTION OVERVIEW

Questions

1 How did the experience feel? What was your main goal of the simulation?

2 Which lab values need to be evaluated for a patient with acute congestive heart failure?

3 Why was lasix, nitroglycerin, Morphine, and CPAP ordered?

4 Describe how you involved family members in patient care being provided.

5 What have you learned from this patient?

6 Describe the scope of practice of all participants in the scenario

7 Describe why you called for help.

8 Did communication include warm handover and closing the loop? How do you know this?

9 Describe how patient information was transferred from one facility to another?

10 What Will You take away from this experience?

CASE CONSIDERATIONS

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Congestive Heart Failure (CHF), or heart failure, is a condition in which the heart canʼt pump enough blood to the bodyʼs other organs. The most common sign of congestive heart failure are edema of lower legs or ankles and/or dyspnea at rest or with minimal exertion. Another symptom is weight gain when fluid builds up. When a specific cause of congestive heart failure is discovered, it should be treated or, if possible corrected.

Monitoring labs during an acute decompensated heart failure episode is important to ensure patient safety and monitor possible side effects of treatment. BNP is a cardiac hormone that will increase during heart failure. Potassium and magnesium are monitored as deficiencies increase the risk of arrhythmias. Creatinine blood level is monitored as a fairly reliable indicator of kidney function.

Administration of lasix helps reduce fluid overload, nitroglycerin and morphine act to vasodilate and pre-load reduce, and CPAP helps to push fluid out of the aveoli,

Patients should be educated regarding not only diet, but also to monitor daily weight and report their weight gain to their physician in order to prevent recurrent episodes of decompensated heart failure.

Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL CENTER

PHYSICIAN ORDERS

PATIENT NAME: Stevyanovich, Peter

DOB: 06/10/1941 MR#: 98126534AGE: 71 Years Old GENDER: MALEHEIGHT: 72 Inches WEIGHT: 90 Kg

DIAGNOSIS:

Congestive Heart FailureFailure to Thrive

NO KNOWN ALLERGIES ALLERGIES AND SENSITIVITIESINAPSINE

DATE TIME PHYSICIAN/PROVIDER ORDER(S) and SIGNATURE

Admit to Rehabilitation Unit

Status - Full Code

4gm Na, low cholesterol diet

Vital signs q 4 hours

Activity - Daily PT, OT, additional movement as tolerated

Daily Weight Checks

Lasix 40mg PO BID

Coreg 3.125mg PO BID

Lisinopril 20mg PO QD

Plavix 75mg PO QD

Coumadin 2.5mg PO QD

Spironolactone 12.5mg PO QD

Insert Foley Catheter

Lasix IV 50mg IV twice/day

D/C po Lasix

Insert IV Angio

T/O Dr. William Caset / Jane Sullivan RN

PHYSICIAN/PROVIDER SIGNATURE Dr. William Casey

DATE 02/25/13

X

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL CENTER

PHYSICIAN ORDERS

PATIENT NAME: Stevyanovich, Peter

DOB: 06/10/1941 MR#: 98126534AGE: 71 Years Old GENDER: MALEHEIGHT: 72 Inches WEIGHT: 90 Kg

DIAGNOSIS:

Congestive Heart Failure Exacerbation

NO KNOWN ALLERGIES ALLERGIES AND SENSITIVITIESINAPSINE

DATE TIME PHYSICIAN/PROVIDER STAT ORDER(S) and SIGNATURE

Oxygen Therapy ( Hi-Flo)

IV Therapy (if not already established)

Determine pre-medication urinary output levels

.4mg Niitroglycerin SL up to 3 dosage (as long as systolic BP remains above 100mm/hg)

80mg Lasix IVP

Morphine Sulfate 4mg IVP now

vitals signs q 5-10 minutes until transfer to Emergency Department

Respiratory Care Consult

CPAP 5-10mm/hg as tolerated

Call urinary output and patient condition after 20 minutes

STAT Labs . - BNP, CMP, CBC, CPK-MB, Tropinin-I, PT-INR, Pre-Albumin

CXR & 12 Lead EKG

PHYSICIAN/PROVIDER SIGNATURE Dr. William Casey

DATE 02/25/13

X

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL CENTER

Laboratory Results

PATIENT NAME: Stevyanovich, Peter

DOB: 06/10/1941 MR#: 98126534AGE: 71 Years Old GENDER: MALEHEIGHT: 72 Inches WEIGHT: 90 Kg

DATE: 24 February 2013Time: 13:10CLLS: J.SmithDIAGNOSIS: Congestive Heart Failure Exacerbation

TEST Results Unit Flag Reference Range

Sodium 149 mmol/L High 135-145

Potassium 3.9 mmol.L 3.6 - 5.2

Chloride 107 mmol/L 101-111

CO2 35 mmol/L High 21-31

Calcium 9.3 mg/dl 8.4-10.2

Glucose 134 mg/dl High 70-105

BUN 10 mg/dl 7-18

Bicarbonate 20 mEq/L Low 22-28

Creatine 1.9 mg/dl High 0.5-1.2

Hemoglobin 12.5 G/dl Low 13-17

Hematocrit 33% % Low 40-51

Digoxin 0.8 ng/ml .8-2.0

platelets 168 Thou/uL 125-390

BNP 300 pg/ml High 0.0-100.0

Troponin-I 11.94 ng/ml <0.15

Creatine Kinase 200 units/L High 38-174

ph 7.48 High 7.35 - 7.45

pre-albumin 46 mg/dl 20-50

INR 2.5 2.0-3.0

CLLS Evaluator Julia Smith MLS ASCP

DATE 02/24/13

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL CENTER

Laboratory Results

PATIENT NAME: Stevyanovich, Peter

DOB: 06/10/1941 MR#: 98126534AGE: 71 Years Old GENDER: MALEHEIGHT: 72 Inches WEIGHT: 90 Kg

DATE: 25 February 2013Time: 14:10CLLS: R. MazzaDIAGNOSIS: Congestive Heart Failure Exacerbation

TEST Results Unit Flag Reference Range

Sodium 130 mmol/L Low 135-145

Potassium 3.9 mmol.L 3.6 - 5.2

Chloride 107 mmol/L 101-111

CO2 44 mmol/L High 21-31

Calcium 9.2 mg/dl 8.4-10.2

Glucose 124 mg/dl High 70-105

BUN 11 mg/dl 7-18

Bicarbonate 18 mEq/L Low 22-28

Creatine 2.1 mg/dl High 0.5-1.2

Hemoglobin 12.5 G/dl Low 13-17

Hematocrit 32% % Low 40-51

platelets 168 Thou/uL 125-390

BNP 626 pg/ml High 0.0-100.0

Troponin-I 13.64 ng/ml <0.15

Creatine Kinase 212 units/L High 38-174

ph 7.55 High 7.35 - 7.45

pre-albumin 46 mg/dl 20-50

INR 2.5 2.0-3.0

CLLS Evaluator Robert Mazza MLS ASCP

DATE 02/25/13

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL CENTER

PATIENT INFORMATION CARD

MEDICATIONS:

Patientʼs Name: Stevyanovich, Peter" Age: 71" " " Gender: MaleWeight: 90 Kgs Height: 72 Inches Primary Care Provider: Dr. W Casey

Diagnosis: Congestive Heart Failure and Failure to Thrive

Past Medical History: Type II Diabetes, HTN, Hyperlipidemia, Peripheral Neuropathy A-Fib, past Smoker

Advanced Directive: Full Code" " " Consent Obtained: Yes

Fall Precautions: Yes Diet: 4gm Na, Low Cholesterol Contact Person: Margaret Stevyanovich (413) 755-5228

MONITORING:

SOCIAL HISTORY:

ACTIVITY OF DAILY LIVING:

ALLERGIES:

DIAGNOSTIC STUDIES:

Coreg 3.125mg twice a dayLasix 4omg twice a dayLisinopril 20mg once a dayPlavix 75mg once a daycoumadin 2.5mg once a daySpironolactone 12.5mg once a day

Inapsine - Anti-Emetic (HIVES)

X X-RaysLabs: CBC, BNO, CMP, CPK-MB, PT-INRTropinin-I, Pre-Albumin

X

X

X

X

Vital Signs - Every HourSPO2Lung and Heart Sounds

Telemetry

Bed Rest, with aggressive PT and OT

Normal ADL - Home, Needs rehabilitation clearance to return to home

Lives with his wife at an home/residence. Is able to ambulate around his home until his hospitalization when patient began with increased shortness of breath and increased weakness. Since then he has been mostly bed bound.RELIGION:" " Jehovah Witness

Medications Brought from Home:

" " None

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

X

SIMS MEDICAL CENTER

PATIENT DOCUMENTATION FORM

SKILL/PROCEDURE

STAFF INITIALS

BLOOD PRESSURE

PULSE/HEART RATE

RESPIRATORY RATE

OXYGEN SATURATION LEVEL (SPO2) Room AIr

OXYGEN SATURATION LEVEL (SPO2) with 02 __ LPM

PAIN LEVEL (Scale 0 - 10)

BLOOD GLUCOSE LEVEL

TEMPERATURE __ oral __ Rectal __ Tempanic

POSITIONING

WOUNDS C = Clean D = Dry I = Intact

WOUNDS BANDAGED

Patient Weight

Dat

e/Ti

me

Patient Name: ____________________________ DOB:________________________MR#:_______________________ PCP:__________________________ Room#:______________

Comments:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL CENTERData Collection Tool

Resident Name:___Peter Stevyanovich_______ DATE of Transfer:__________________________

Student Name:__________________________" FACULTY:______________________________ Student Name:__________________________" Operator:_______________________________

Collectorʼs Name:__________________________" Start Time:___________ End Time:_________

# Question ResponseYes

ResponseNo

Comments

1 Resident Face Sheet (or similar document) Containing patient name, birth date, rehab facility info

2 Reason for Transfer (Check Method)

EMS transfer form Verbal communication

3 Past Medical History (H&P form, MDS)

4 Medication List (MAR, EMR Printout)

5 Allergy List (MAR, Face Sheet)

6 Baseline mental and physical function (seven-day look back, MDS)

7 Advance Directive (DNR Status, Living Will)

8 Recent Vital Signs (vital sign book, nursing notes)

9 Recent Lab Work (Lab Reports)

10 Rehabilitation Unit nurse contact name and phone number (Verbal Communication vs EMS Transfer)

11 Physician contact name (verbal communication, Face Sheet)

Any evidence of the following actions?

12 Name of Ed/Hospital transfer communicated to PCP.Medical record review (nursing notes, progress notes)

13 Resident clinical status on transfer communicated to primary care physicianMedical record review ( nursing notes, progress notes)

14 Evidence of Family/caregiver notificationMedical record review (nursing notes, progress reports)

15 information transferred within 60 minutes of departureMedical Record Review (nursing notes, progress reports)

16 Verbal Follow up with hospital by rehabilitation unitMedical record review ( nursing notes, progress reports)

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

RESIDENT INFORMATION CHECKLIST FOR ED/HOSPITAL TRANSFER

SIMS MEDICAL CENTER

Resident Face Sheet (or similar document) containing patient name, birth date, rehabilitation facility name and phone number.

Reason for transfer (Check Method) EMS Transfer Form Verbal Communication

Past medical History (e.g., annual review, history and physical form, MDS)

Medication List (e.g., medication administration record, EMR printout)

Allergy List (e.g, medication administration record, face sheet)

Baseline mental and physical functioning (e.g., seven day look-back, MDS)

Advance Directive (e.g, DNR status, living will, MOLST)

Recent vital signs (e.g., vital sign book, nursing notes, verbal communication)

Recent lab work (lab reports)

Rehabilitation Facilities contact name and phone number (e.g., verbal communication, EMS transfer form)

THE FOLLOWING INFORMATION IS DOCUMENTED IN THE MEDICAL RECORD:

Name of ED/Hospital transfer communicated to primary care physicianResident clinical status on transfer communicated to primary care physicianEvidence of family/caregiver notificationThe information above was transferred with the resident or within 60 minutes of departure from the facility.

Contact Name:_________________________________________ Time:___________________________

________________________________________________ ____________________________ NAME DATE

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

___________________________________________ _____________________________ RESIDENT NAME Date and time of transfer

SIMS MEDICAL CENTERProficiency Self Report

# Met Not Met

OBJECTIVE E A D N N/A Comments

1 Wash Hands

2 Maintains Universal Precautions

3 Introduce Self and Identifies the Patient ( Minimum two (2) Patient identifiers)

4 Maintains Patient Privacy (Pull Curtain if Applicable)

5 Auscultates Heart and lung sounds

6 Obtains Blood Pressure, pulse rate, respiratory rate, SPO2 levels and temperature

7 Assess IV Site

8 Evaluates Urine Output

9 Evaluates lab Data

10 Recognizes Respiratory Failure

11 Communicates findings directly to PCP

12 Receives orders, repeats back

13 Explain Lab values and medication to patient

14 Request assistance from Resp Care Therapy

15 Properly administers Nitroglycerin, Lasix & Morphine

16 Assist Resp Care with CPAP

17 Evaluates vital signs and urine output & Ascultate Lungs

18 Communicate therapeutically with patient and family

19 Communicates findings and need with fellow health care providers caring for the patient.

20 Requests approval for transport ro ED for patient

21 completes all necessary paperwork

22 Contacts receiving facility and gives report about patient

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

Please rate your performance in the simulation using the following scale: ( See back side for more explanation of levels)E = Exemplary A = Accomplished D = Developing N = Novice N/A or N/O = Not Applicable or Not Observed

STUDENT NAME:____________________________ Date:_______________________

FACULTY NAME:_____________________________

SIMS MEDICAL CENTERFaculty Evaluation Tool

Student Leader:__________________________ DATE:_________________________________

Student Name:__________________________ FACULTY:______________________________

Student Name:__________________________ Operator:_______________________________

Student Name:__________________________ Start Time:___________ End Time:_________

# Met Not Met

OBJECTIVE E A D N N/A Comments

1 Wash Hands

2 Maintains Universal Precautions

3 Introduce Self and Identifies the Patient ( Minimum two (2) Patient identifiers)

4 Maintains Patient Privacy (Pull Curtain if Applicable)

5 Auscultates Heart and lung sounds

6 Obtains Blood Pressure, pulse rate, respiratory rate, SPO2 levels and temperature

7 Assess IV Site

8 Evaluates Urine Output

9 Evaluates lab Data

10 Recognizes Respiratory Failure

11 Communicates findings directly to PCP

12 Receives orders, repeats back

13 Explain Lab values and medication to patient

14 Request assistance from Resp Care Therapy

15 Properly administers Nitroglycerin, Lasix & Morphine

16 Assist Resp Care with CPAP

17 Evaluates vital signs and urine output & Ascultate Lungs

18 Communicate therapeutically with patient and family

19 Communicates findings and need with fellow health care providers caring for the patient.

20 Requests approval for transport ro ED for patient

21 completes all necessary paperwork

22 Contacts receiving facility and gives report about patient

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL CENTEREVALUATION RUBRIC

EXEMPLARY ACCOMPLISHED DEVELOPING NOVICE

- Observes and monitors

- Recognizes subtle changes

- Assertively seeks needed info

- Constantly delegates

- Identifies and independently develops

- Focuses on relevant data

- Observes and monitors

- Recognizes obvious change

- Actively seeks useful info

- Generally delegates with clarity

- Usually flexible with change

- Good self-reflection

- Attempts to observe, overwhelmed

- Notes obvious deviations

- Attempts to prioritize data

- Tentative leadership

- Caring but not competent skills

- Hesitant and ineffective

- Confused

- Unable to note critical data

- Fails to interact

- Disorganized

- Inflexible

- Focused on Single intervention

- Under/Overly critical

Please use the information below as examples of each level of development for this evaluation rubric/tool. Please answer each question honestly to assist you in the educational process.

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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL CENTERStudent Evaluation Tool

# Question SA A N D SD

1 I understood my role in the scenario

2 I understood the purpose and objectives of the simulation

3 The information I received before the scenario was helpful in preparing me for the scenario

4 The scenario provided me an opportunity to practice critical think skills

5 The scenario resembled a real-life situation

6 I was supported in the learning process

7 My need for help was recognized

8 I was encouraged to explore all possibilities during the simulation

9 I think I would be better able to perform in a related clinical situation after participating in this scenario.

10 The feedback was constructive

11 The debriefing session was helpful in my understanding of the clinical situation and the most appropriate actions for the participant to take.

12 Overall, I think this was a valuable learning experience

What was your role in the scenario:

What was the single greatest thing you got out of this scenario? (If you feel nothing at all from it, please say why you found it so unproductive)

What was most helpful/beneficial about this scenario?

What did you find least helpful/beneficial about the scenario?

In what ways could the scenario be improved or made to be more realistic?

FACULTY NAME:_________________________" " Date:_______________________

Student Name (Optional):________________________ Course:_____________________

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Please choose the answer you feel best represents your simulation experience for the questions belowWe greatly appreciate all of your feedback !!!

SA - Strongly Agree A - Agree N - Neutral D - Disagree SD - Strongly DIsagree

Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

SIMS MEDICAL CENTERCare Transitions Education Project (CTEP) Care of the CHF Patient - Part 1

22

REFERENCES

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• Coleman EA. Transitional Care Performance Measurement. In Institute of Medicine. Performance Measurement: Accelerating Improvement. National Academy of Sciences Press. Washington DC. December 2005.

• Coleman EA, Magid DJ, Beck A, Eilertsen TB, Conner D, Kramer AM. Reducing Emergency Visits in Older Adults with Chronic Illness: A Randomized Controlled Trial of Group Visits. Effective Clinical Practice (An ACP/ASIM Publication). 2001;(2):49-57.

• Coleman EA, May K, Bennett RE. Health Information Exchange in Post Acute and Long Term Care - Task 5.0 Report on HIE in Post-Acute and Long-Term Care. Department of Health and Human Services Assistant Secretary for Planning and Evaluation. Contract #100-03-0028.

• Bennett RE, Tuttle M, May K, Harvell J, Coleman EA. Health Information in Post-Acute and Long-Term Care: Case Study Findings (Final Report). Department of Health and Human Services Assistant Secretary for Planning and Evaluation. Contract #100-03-0028.

• Halasyamani L, Kripalani S, Coleman EA, Schnipper J, van Walraven C, Nagamine J, Torcson P, Bookwalter T, Budnitz T, Manning D. Transition of care for hospitalized elderly - the development of a Discharge Checklist for Hospitalists. Journal of Hospital Medicine. 2006;(1):354-360.

• Jefferies, P. (2007) Simulation in Nursing Education. Laerdal Wappingers Fall, NY

• Lasater, K. Clinical Judgement Development: Using Simulation to Create an Assessment Rubric Journal of Nursing Education. 2007 Vol. 46 (11) : 496-503

• Minor, M. Minor, S. (2009) Patient Care Skills 6th Ed. Prentice Hall, Saddle River, NJ

• Stanhope, M., Lancaster, J. (1996) Community Health Nursing 4th Ed. CH 7 pp 117-135 Mosby Boston, M

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