Welcome‘Teaching Patient Safety’

Laerdal SUN 2009 San Francisco, California

October 21, 2009

Brief Introduction

• Laura Mosesso– Project Manager, SimMedical

• Aimee Smith– Production Manager, Curriculum Development

WISER/SimMedical

Agenda• Tell us about you!

– Audience Response System

• What are Response Teams and Initial Responders?• Simulation Session• Debriefing Exercise• Curriculum Exercise• Courseware Review• Question and Answer Session

What is your primary role at your facility?

1. Clinician2. Clinical Educator3. Educator (Not

clinically active)4. Administrator5. Simulation Operator6. Other

If you are a clinician, tell us more!

RN M

D

Respira

tory

Therapist

Paramedic

/ EM

T O

ther

0% 0% 0%0%0%

1. RN2. MD3. Respiratory

Therapist4. Paramedic / EMT5. Other

Why are you here? Are you interested in…

Rapid resp

onse te

am tra..

.

Initi

al in-hosp

ital re

spon...

Learn

ing what o

thers

ar...

Lookin

g for w

ays to

imp...

0% 0%0%0%

1. Rapid response team training2. Initial in-hospital responder

training (prior to code team arrival)

3. Learning what others are doing4. Looking for ways to improve

what you are already doing

What are you currently doing for Team or Initial Responder training?

Course m

ateria

...

Course m

ateria

...

Simulation se

s...

Not t

eaching

0% 0%0%0%

1. Course material only2. Course material and

simulation sessions3. Simulation sessions

only4. Not teaching

Why Simulation-Based Training?

In the United States:• Average 1.2 million healthcare related incidents per

year

• $29 billion a year associated with medical errors

• 66% of medical errors are associated with communication issues

Why Simulation-Based Training?

According to the 1999 Institute of Medicine Report ‘To Err Is Human’,

approximately 100,000 Americans die each year from ‘preventable’ hospital errors. The annual toll exceeds the combined

number of deaths and injuries from motor vehicle and airline crashes, suicides, falls,

poisonings and drownings.

Why Simulation-Based Training?

“The Committee believes that health care organizations should establish team training programs for personnel in critical care areas (e.g., the emergency department, intensive

care unit, operating room) using proven methods such as the crew resource

management techniques employed in aviation, including simulation.”

To Err Is Human; Building a Safer Health System

WHAT is a Rapid Response Team?• Also known as Crisis Team (CT), Medical Emergency Response

Team (MET) or Code Team– Teams of clinicians rush to a patient’s location whenever a

clinician feels the patient’s condition is deteriorating or has deteriorated

– Teams are designed to rescue patients early in their decline, before an adverse outcome occurs

• Hospitals using Rapid Response Teams report reductions in the number of cardiac arrests, unplanned transfers to the ICU and in some cases, overall mortality rates

WHY Rapid Response Team Training?

• The Joint Commission– 2008 National Patient Safety Goals

• Goal 16: Improve recognition and response to changes in a patient’s condition.

o16A: The organization selects a suitable method that enables health care staff members to directly request additional assistance from a specially trained individual(s) when the patient’s condition appears to be worsening

WHY Rapid Response Team Training?

• IHI: Institute for Healthcare Improvement 100,000 Lives Campaign– Introduces proven best practices to extend or save as

many as 100,000 lives by reducing morbidity and mortality

– Activating a Rapid Response Team is one of six strategies to prevent avoidable deaths

• Deploy Rapid Response Teams…at the first sign of patient decline

WHAT is an Initial Responder?

• Wikipedia– Initial or First Responder is a term used to

describe the first medically-trained responder to arrive on scene of an emergency

– The first stage of being a first responder is being able to recognize what it is that you are required to know and perform the necessary interventions

WHY Initial Responder Training?• To address CRITICAL INCIDENTS

– High percentage outside critical care areas– Survival highly dependent on Initial Responders– Multiple factors influencing patient outcomes include:

• Patient co-morbidities and initial cardiac rhythm • Duration of incident and time to defibrillation

– Need for rapid and effective BLS and ACLS

• Importance of sufficiently trained personnel– Perform effective BLS– Initiate early intervention and defibrillation if needed

• AED utilization– Less intimidating– Support rapid defibrillation

WHY Initial Responder Training?

• On average, greater than 9 minutes to shock patient

• Less than 10% of patients are provided proper BVM ventilation

• 40% of nurses did not know the correct phone number to activate the Rapid Response Team

• Patient report was inconsistent

• 80% of nurses did not set the defibrillator to the appropriate mode

WHY Initial Responder Training?

How do you run scenarios?

On th

e fly

Progra

mmed but alw

ays...

Prepro

grammed

0% 0%0%

1. On the fly2. Programmed but always

tweaking3. Preprogrammed

*may select more than one answer

How do you debrief?

Record

video

Use

check

lists

Collect

data

Utiliz

e Laerd

a...

Oth

er

0% 0% 0%0%0%

*may select more than one answer

1. Record video2. Use checklists3. Collect data4. Utilize Laerdal software and

hardware 5. Other

Simulation Scenario• 3 volunteers needed• 3-5 minute scenario• Observers - please take notes to debrief as you

would normally at your organization• Volunteers - scenario orientation to:

– Setting– Equipment– Roles

Patient Report

Location: Non-Monitored Bed UnitPatient: William RobertsPatient Information: 82 year old male post-

operative for hernia repairPast Medical History: Myocardial Infarction

(4 years ago)Meds: Aspirin daily

Debriefing Exercise

Please share 1 -2 of your debriefing points.

Problem with current debriefing methods (pick your greatest pain)

Too many i

nstructo

rs de...

Ineffecti

ve asse

ssment t

ools

Lack

of stan

dard debrie

fi..

Inco

nsiste

nt sce

nario pr..

.

0% 0%0%0%

1. Too many instructors debriefing differently

2. Ineffective assessment tools

3. Lack of standard debriefing points

4. Inconsistent scenario progression

Tools• Think back to the scenario…let’s discuss the

following:– Would tools have helped with the assessment?

– Do you feel tools would help relate the debriefing to scenario objectives?

– Would tools provide standardization to the instructor community?

– Is it important to assess the same way with each training / scenario session?

Scoring Tools Exercise

• Think back to the scenario…– Use the Assessment Tool to document volunteer

actions during the scenario

• Let’s discuss the following…– Standardized debriefing points

Scoring Tools

• Standard assessment and debriefing tools help to

– Keep instructors focused

– Clearly outline learning objectives

– Structure debriefing sessions

– Gather valid research data

These are all common problems in simulation-based training today!

What is a Course?

Based on the above information, please share your thoughts on what would go into each

category.

COURSE

Before Class During Class After Class

What is a course?COURSE

Before Class During Class After Class

Participant content

Instructor content

Lecture

Simulation

Debriefing

Assessments

Partnerships

• SimMedical, in partnership with Laerdal Medical, is pioneering simulation-based education materials

• Joint venture offers curricula / courseware that is:

– Developed by board-certified clinicians and other content experts

– Designed with simulation educational methodology that incorporates healthcare best practices

– Created with a variety of learning techniques to maximize retention of material

The First 5 Minutes®All the materials needed to deliver a robust simulation course

• Course Goals:– Early recognition of critically ill hospital patients before the

code team arrives promoting improved outcomes– Establish standardized behaviors for the initial hospital

responders

• Target Audience:– Healthcare staff that are the initial responders to a patient

in crisis such as non-critical care nursing staff, nursing students, respiratory therapists, physical/occupational therapists, et al.

The First 5 Minutes®• Why?

– Floor nurses and other hospital staff are undertrained or are not trained to deal with patients in crisis

– Teaches staff how to manage patients in crisis prior to the actual code team’s arrival

– Part of a hospital quality patient safety program

– Meets regulatory requirements

Rapid Response Team TrainingSimulation-based educational training program

• Course Goals: – Develop critical team building skills– Improve communication– Promotes efficient teamwork

• Target Audience:– Clinicians who are part of the actual code team that take

over from the initial hospital responders– Roles include physician, nurse, pharmacist, and

respiratory therapist

Rapid Response Team Training

• Why?– Promotes the fundamentals of teamwork

– Emphasis on communication

– Strong focus on the importance of practice

– Meets regulatory requirements

– Developed by Michael DeVita, MD• International leader in rapid response systems and

simulation training• Current President, Society for Simulation in Healthcare

SimMedical Courseware – Solutions Focused

Courseware