Design and Implementation of Wearable Task Trainer Proof-of-Concepts

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© Texas Children’s Hospital. All rights reserved.

BACKGROUND

M Pickett, APRN, PNP-BC1,13, T Bentley, RN, BSN2,13, P Lopez, RN, VA-BC3,13, N Pham, MSN, RN, CPEN, CPN4, N Villarreal, BSN, RN, CPEN, SANE-P4, J Milsten5,K Christopherson5, J James5 ’ J Lawrence, MSHP, RRT-NPS6, K Morales, BSN, RN, CCRN, CNP-T, CFC2, A Mitchell, BSN, RNC-NIC, VA-BC PCM3,

S Dean, DNP, APRN, RNFA, WHNP-BC10,13, J Hearne, RN, BSN11,13 , C Roberts, RN, CCRN7,13, J Lambert, RN, CCRN7, R Bowen, RN, CCRN8,13, J DeJean, MSN9,, B Levy, RN, BSN12,13, J Yborra, APRN, CPNP-AC1, B Barraza, APRN, CPNP-AC1, N Pruett, APRN, FNP-BC1, K Romane, APRN, CPNP-AC1, C Doughty, MD, MEd4,6

INNOVATION METHODS

An evaluation of frontline staff training needs from the simulation center,nurse educators, kangaroo transport team, vascular access team, andintensive care units identified several consistent themes.

We discovered a significant educational gap for low-cost, realistic, durable andwearable peripheral intravenous (PIV) and port task trainers that enable moreversatile training options. Easily accessible training videos addressing uniquechallenges in the clinical environment were also identified as a need.

PROJECT GOALSOur goals were to develop and implement novel skills technique videospartnered with PIV and Port Task Trainers designed by frontline innovatorsthat are wearable, cost-effective, durable, realistic, and allow all proceduralsteps trainees would perform. Our secondary goal was to document and vetour innovation process.

Proof-of-Concept Development Process (5 phases)

Proof-of-Concept: Hands-on visual demonstration of an ideaPrototyping helps develop and validate proof-of-concept

Phase 1: Discover and validate the “need” Phase 2: Investigate currently available/utilized products. Stepwise approach to evaluate new and existing products that have potential to solve the problem. Explore all the possible ways that a specific need can be solved without creating a new product.Phase 3: New product development - Prototype design and fabrication with end user feedbackPhase 4: New product pilot and survey Phase 5: Implement and share

Phase 4 and 5: Pilot and Implementation

LESSONS LEARNED

Prototype development • Avoid analysis paralysis • Innovation is a marathon not a sprint. (Manage expectations)• Start with basic materials to determine the size, shape and concept prior to

developing refined prototypes.• Expect multiple iterations during prototype development

• Utilize simulation/end user feedback to evaluate each prototype• Test, document findings adjust, design, and repeat

• Ensure to budget the appropriate number of prototypes for end user feedback• Start with small focus group, increase size as project develops momentum

Videography • Prepare and practice script before filming.• Smart phone mounted on spider tripod, gimbal, or body mount.• Film and take pictures horizontal (helps with video editing).• Film different angles simultaneously while talking through skill.• Be aware of back drop, wear gloves and turn phones on silence.• Share videos via YouTube (unlisted) or Gmail

1. TCH Cardiovascular Anesthesia; 2. TCH Kangaroo Crew; 3. TCH Vascular Access Team; 4. TCH Emergency Center; 5. Sawbones© Design Engineer; 6. TCH Simulation Center; 7. TCH CVICU; 8. TCH PICU; 9. TCH Hematology; 10. TCH Women’s Health; 11. TCH Float Pool Educator; 12. TCH NICU; 13. TCH Innovative Solutions Council

RediStik Wearable PIV Trainer Pilot Outcomes:• 14 clinical areas surveyed within Texas Children’s Hospital

100% (100 surveyed) recommended to their colleagues for training• Quick setup for Just-in-Time Training and simulation scenarios• Worn on a person/mannequin increased staff engagement • Large and small rolling vein provide scenarios for palpation/stabilization and

difficult access techniques • Progress from novice to advance in venipuncture and PIV insertion• Life expectancy averages 1,000+ punctures with 24 GA needles• Utilized throughout TCH and Global HOPE clinics in Sub-Saharan Africa• Other applications identified: patient self-infusion, fistula access, PICC line

care/maintenance and vein viewer technology simulation trainers

RediStik Wearable Port Trainer Pilot Outcomes:• Five clinical areas surveyed within Texas Children’s Hospital -

100% (67 surveyed) recommended to their colleagues for training• Simulation options for superficial, normal, deep, angled, and float port

positioning depths• Progress from novice to advance in port access, de-access, positioning and

trouble shooting• Quick setup for Just-in-Time Training and simulation scenarios• Worn on a person/mannequin increased staff engagement • Life expectancy for removable skin averages 1,200+ punctures• Utilized throughout TCH and Global HOPE clinics in Sub-Saharan Africa• Other applications identified: Renal service training port access with an

apheresis needle

Outcomes of the project vetted a step-wise approach to develop and implement the RediStik Wearable PIV and Port Task Trainer proof-of-concept using innovation processes/tools, low-budget technology, and novel skills videos.

RediStik Wearable Task Trainers were designed and piloted by frontline innovators at Texas Children’s Hospital® in collaboration with Sawbones®

Versatile, easy to set-up simulation training kit, provides wearable, durable, realistic task trainers allowing all procedural steps from skin preparation, vascular access, blood draws/flushing to dressing application.

Visit www.texaschildrens.org/redistikto access video playlists and data results

• Identified need for versatile, durable and realistic PIV and port task trainers• Validated need with Simulation center, educators, and staff representing

emergency center, hematology-oncology, kangaroo transportation crew, vascular access team and pediatric intensive care units

• Quality indicators potentially impacted by development and dissemination of task trainers and skills technique videos• Increase staff competency/confidence on vascular access. • Increase staff, patient and family satisfaction.• Decrease PIV infiltrates, vascular access nurse calls.

• Product search on existing trainers and fabrication materials• Internal institution (TCH): Simulation center, business/innovation,

biomedical engineering, and frontline innovators• External institution: Google, YouTube, literature search and

manufacturers.• Documented results: (Microsoft OneNote very useful tool)

• Notes on products: hyperlink, screen shots, price, indications for use, population intended and innovators notes on how the product or material may contribute to the solution.

PDSA cyclesCycle 1: (2016)

• 7 prototypes fabricated testing needle-proof backing, tissue optionsand wearable design concept.

• Modifications based on focus group feedback

Cycle 2: (2017)• Presented refined prototypes to key stakeholders for funding.• Collaboration with Sawbones Medical Simulation Manufacturers • 12 prototypes to achieve final product• Modifications based on focus group feedback

Cycle 3: (2018-2019)• Piloted PIV and Port Trainers on TCH campus and Global HOPE clinics in

Sub-Saharan Africa• Incorporated latest product design and skills tips and technique video

Phase 1: Discover/Validate Need”

Phase 2: Investigate Current Products

Phase 3: New Product Development

Final PIV Design Outcomes

NEXT STEPS

• Continue to develop PIV, Port and CVC Tips and Techniques skills video playlist• CVC Care Trainer Kit development• Texas Children’s Global HOPE video series• Continue to collect PIV insertion outcomes

Final Port Design Outcomes

Outcomes

SimVent IMSH Presentation 2020