Improving Care for Pediatrics Nancy M. Tofil , M.D., M.Ed. October 2011
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Transcript of Improving Care for Pediatrics Nancy M. Tofil , M.D., M.Ed. October 2011
Improving Care for PediatricsNancy M. Tofil, M.D., M.Ed.
October 2011
Disclosure
• I have no conflict of interests to disclose
Overview
0-5min Introduction/Turning Point Slides5-15min Objectives15-45min Review Pediatric courses and
opportunities45-60min TAPPS – List barriers and discuss
strategies to overcome to overcome the barriers
60-75min Wrap-up / Top 10
How long have you been involved in simulation?
0-6month
s
6-12mont
hs
12-18months
18-24months
2-5years
>5years
17% 17% 17%17%17%17%
1. 0-6months2. 6-12months3. 12-18 months4. 18-24 months5. 2-5 years6. > 5years
What is your role?
Simulat
ion te
c...
Nurse ed
ucator
Physici
an/ A
dv...
Administrat
or
Other
20% 20% 20%20%20%
1. Simulation technologist2. Nurse educator3. Physician/ Advanced
provider4. Administrator5. Other
Who is your primary learner?
Nurse
Med
ical S
tuden...
Residen
ts
Staff P
hysici
a...
EMT O
ther
17% 17% 17%17%17%17%
1. Nurse2. Medical Student3. Resident4. Staff Physician5. EMT6. Other
Where is your center located?
Free st
anding
In hosp
ital
In nursi
ng or ...
In m
edica
l sch
...
Other
20% 20% 20%20%20%1. Free standing2. In hospital3. In nursing or allied health
school4. In medical school5. Other
Which high-fidelity pediatric simulators do you have?
Laerd
al
METI
Gau
mard
More
than one .
..
25% 25%25%25%
1. Laerdal SimBaby2. Laerdal SimNewB3. METI Child4. Gaumard 5. More than one type6. None yet
What do you feel is the biggest obstacle you face concerning moving simulation
forward at your institution?
1. Financial related2. Technical knowledge3. Time constraints4. Hospital support
What is your primary goal from this workshop?
1. Programming Advice2. Ideas for pediatric sim
courses3. Strategies to move your
center ahead4. Product advice5. Obtain new scenarios6. Other
Learning Objectives
1. Discuss the medical/legal environment in the pediatrics area
2. Identify issues specific to pediatric care3. Describe the history of pediatric simulation4. Describe the role of simulation in providing
quality pediatric education5. Discuss collaboration with multidisciplinary
leadership6. Describe how to plan and implement pediatric
simulation7. Define measurable objectives for success
Medical/Legal Environment
1. Patient safety2. Resident duty hours3. Transition of responsibility to fellows and
attendings4. Nursing students less exposure5. New nurses less skilled
Issues Specific to Pediatrics
• Multiple sizes• Multiple normal values
– Vital Signs– Laboratory Values– Radiograph findings
• Many patients unable to explain their concerns• Interaction of care givers• Social concerns• Kids are never supposed to die
History of Pediatric Simulation
• Laerdal SimBaby – released 2005• Laerdal SimNewB – released 2009• METI Child – released 2006• Gaumard HAL – released early 2000’s• Laerdal SimChild - soon• Always behind adult technology• Never will have as much potential profit
Role of Simulation in Providing Quality Pediatric Education
First Year Second Year
Third Year Fourth Year
0
2
4
6
8
10
12
OldNewYears after professional degree
Hou
rs o
f exp
erie
nce
(in
thou
sand
s)1. Clinical
Education Inefficient2. No Debriefing3. No scheduled
admissions
Role of Simulation in Providing Quality Pediatric Education
• John Dewey, “All genuine education comes about through experience but not all experience educates and some experience mis-educates”
• Experience is the backbone of adult learning theory
Kolb’s Experiential Learning Cycle*
ConcreteExperience
ReflectiveObservation
Abstract conceptualization
Active experimentation
Debriefing
Relating to actual situations, developing rules, algorithms
Practicing
*Kurt Lewen
Simulation
1.Standardize exposure2.Scheduled debriefing
• Began August 2007• 8 Mannequins • 3 Simulation rooms• Conference room• Audiovisual capability
in all rooms• Storage
Children’s of Alabama Pediatric Simulation Center
15,000 learners
• SimBaby x2• SimNewB• SimMan• SimMan Essential• METI PediaSim• Gaumard Pediatric
Hal 1 Year• Gaumard Pediatric
Hal 5 Year
Our Mannequins
1. Radiology (Attending and Technologist)2. ECMO (ECMO Team)3. PICU (Physician, Nurse and Pharmacy)4. Mock Code (Code Team)5. Trauma (Trauma Team)6. Death and Dying (Physician, Nurse, Social Work and
Chaplain)7. Forensic Evidence (Physician, Nurse)8. Medical Student Clerkship (Medical, Nursing and
Pharmacy Students) 9. Sedation (Physician, Nurse, Technologist)10. Cardiovascular (Physician, Nurse Practitioner, Nurse)
Multidisciplinary Courses
ECMO
PICU
Mock Code
Trauma
Death and Dying
Forensics – Sexual Abuse Evidence Collection
1. Orthopedics2. Anesthesia and CRNA3. Pharmacy Student4. PICU Nursing5. Solid Organ Transplant Nursing6. Dialysis Nursing7. NICU Nursing
“Silo” Courses
Orthopedics
Anesthesia and CRNA
NICU Nursing
1. Nursing Skills Labs (First 5 Minutes of a Code)2. PALS3. Geriatrics4. NRP5. Clinical Assistant6. New Hire Nursing Assessment7. Sleep Technologists8. Nursing Mock Code Orientation9. Home Ventilator10. Teen Trauma Prevention 11. Medication Errors
Specialty Courses
Geriatrics
Home Ventilator Simulation for Parents
• Tracheostomy• Intubation• Basic Airway• Surgical Airway• Crisis Resource Management • Intern Skills• ENT Foreign Body Removal
Workshops
Basic & Advanced Airway
ENT Foreign Body Retrieval
Intern Skills
• Request comes in or need identified• Face to face meeting• Content expert identified• Learners identified• Goals and objectives • What simulation can and cannot do• Specific cases discussed
Where to begin
IDEAS FOR CASES1. Sentinel events2. Near misses 3. Rare events (contrast reactions) 4. Safety & equipment issues5. Requests6. Codes7. Premature Closure8. Hand offs
• Who? Learners, content expert, simulation staff• What? Objectives, take away points• When? Frequency• Where? Simulation Center, in situ, somewhere else• Why? Change in knowledge, skills, attitudes• How? Moulage, labs, xrays, equipment
Process
RESOURCES1. Online: forms, scenarios, programming, moulage2. Internal: staff3. Networking4. Organizations5. List serves
• Moulage• Family members• Xrays, labs, ECG• Clothes, wigs, toys,
eyeglasses• Voices• Use real equipment (no
pretending)• Unusual distracters (impaired
clinician, family issues)
Make It Interesting
Moulage
Accessorize
Evaluation: Generic
I am a • MD • RN• Resp Therapy • Pharmacist• Radiology Tech• Nursing Student• Medical Student• Chaplain• Social Work• Other_______
Agree Neither Agreenor Disagree
Disagree
I found to be valuable learning experience.
Debriefing and group discussion were valuable learning Experiences.
I will be able to apply what I have learned in my work position/job.
I was challenged in my thinking and decision-making skills.
I developed a better understanding of the management of pediatric disorders/emergencies.
This experience has increased my confidence level in pediatric disorders/emergencies
This experience has increased my skill level in pediatric disorders/emergencies.
I feel better prepared to care for real pediatric patients.
I learned as much from observing my peers as I did when I was actively involved in caring for the simulated patient.
I would recommend this program to others.
The Instructor(s) was knowledgeable about the subject(s) presented.
My personal objectives for this course were met.
Evaluation
1. Do you feel your participation in this course will improve your performance as you encounter medical complications in the actual clinic setting?
2. Two things I liked/learned today: a) b)
3. Two things I wish we had focused on or that could be improved: a) b)
Comment/Suggestions/Recommendations:
TAPPS
• TAPPS – Think Aloud Paired Problem Solving1
• Active Learning Technique• Pair up• Discuss proposed problem• As instructor state, “We will do this exercise for
___ minutes. I will give you a 1 min heads up. At the completion of the exercise I will call on some groups to share their thoughts. Does anyone have any questions before we get started.”
1. Harvey Brighton
Top 10 Things that Helped our Simulation Center to Succeed
10. Simulator Voice– 10W Guitar Amp ($60)– RadioShack 170 MHZ wireless lapel
microphone ($50)– 72inch LPM cable ($5)
PRICELESS
Top 10
9. Caregiver (parent, spouse, child)– Hospital volunteer– Medical student
Top 10
8. Free/ Nearly Free Supplies– X-rays – Laboratory reports– Costumes (thrift stores)– Trash bins (Stroller, IV pumps) – Expired medical supplies
Top 10
7. Short scenarios (10-15min) and long debriefings (20-45min)
– Start with scenarios you feel most comfortable with and expand from there
– Same stem for multiple learners – make it more gray for more advanced learners
• JW, F8 def– Change rhythms
Top 10
6. The Basic Assumption
Everyone participating in activities at the Children’s Hospital Pediatric Simulation Center is intelligent, well-
trained and dedicated to improve their care for children.1
1. Adapted from Center for Medical Simulation, Boston MA
Top 10
5. Relatively simple video system
– Video-switcher • Picture in Picture
– Apple – I Movie
Top 10
4. Weekly simulation team meetings– Keeps everyone accountable to each other
Top 10
3. Make friends – High and Low Places– Housecleaning– Pharmacy – Engineering– Security– Hospital volunteers– Hospital CEO
Top 10
2. Candy!!– Everyone learns more when fed!!
Top 10
1. Have fun and keep it simple
Celebrate Success
I hear and I forgetI see and I rememberI do and I understand
Confucius, 551-479 BC