1. 2011 SUN eLearning eSimulation in Action

2. Goal of this Interaction: Discuss implementation and deployment of a successful eSimulation program leading to improvement in efficiency, skills retention and employee satisfaction at MU Health Care.

3. eSimulation in Action Outcomes of this interaction… We will discuss how eLearning and eSimulation at MUHC : Improved skills and teamwork Increased training efficiency Reduced costs Trained more people in less time with fewer instructors Improved employee satisfaction, confidence and competence Saved lives!

4. In the Heart of the Midwest eSimulation in Action MU Health Care… Level 1 Trauma Center for large area of Missouri-rural Schools of Medicine, Nursing, Health Professions Shelden Clinical Simulation Center, CED Skills Lab, SON Simulation Lab Chest Pain Center JC Primary Stroke Center AHA Training Center Missouri University Health System 475 beds MUHC >500 medical staff members MUHC 1600 nurses MUHC Includes MU Health Care, Missouri Rehabilitation Center, Women’s and Children’s Hospital, Missouri Orthopedic Center. Missouri University Psychiatric Center, Ellis Fischel Cancer Hospital, Internal and Outside Clinics

5. eSimulation in Action Training at MU Health Care >2100 participants trained annually for BLS (live classes, BLS Online, BLS HC) >900 participants trained annually for ACLS (live classes, ACLS HC) >450 participants trained annually for PALS (live classes, PALS HC) >750-1000 participants annually- Mock Code Training >2500 participants annually Simulation Classes

6. eSimulation in Action Training at MU Health Care >80-100 participants trained annually for AACN ECCO >500 participants trained annually for Stroke Education >50,000 In house WBT annual training >80,000 EMR annual training >275 NRP training annually- online after 2011

7. eSimulation in Action Training at MU Health Care Goal is to implement and provide a diverse number of training options for all learning styles and work schedules, to improve efficiency in skills training, to improve skill retention and staff satisfaction and to save lives.

8. eSimulation in Action Approach To Training 1.Live training/traditional classroom 2.eLearning with HeartCode, BLS Online, other self directed online learning 3.Simulation 4.Blending eLearning and eSimulation approaches

9. eSimulation in Action Live training/traditional classroom Familiar environment, more comfortable for some Training costs can be higher May improve knowledge but not necessarily practice Need space, instructors, time

10. eSimulation in Action eLearning & eSimulation Focus today on: Heartcode eLearning Mock Code eSimulation Other simulation at MU Health Care

11. eSimulation in Action eLearning with HeartCode Self-Directed Learning eLearning lets the participant learn at their own pace and convenience-independently No certified instructor needed (except PALS HC) This is the age of technology and computers! MU Health Care has used some form of eLearning since the mid to late 80’s. It wasn’t called eLearning back then, but it was the beginning of eLearning.

12. eSimulation in Action eSimulation Reduce errors Improve skills Practice in safe environment Right patient at the right time Learn and practice teamwork! MU Health Care purchased Sim Man in 2005.

13. eSimulation in Action “Having knowledgeable instructors, computer programs and thousands of dollars worth of simulation equipment doesn’t guarantee successful program outcomes nor improve patient outcome.” Author Unknown

14. eSimulation in Action It takes cooperation and a blended approach to learning, using all of the training options available. Learn-Practice-Apply

15. eSimulation in Action Top Ten Things eLearning and eSimulation Can Do: 10. decrease stress in an inherently stressful environment. 9. improve confidence. 8. improve critical thinking in a safe and controlled environment. 7. allow participants to learn from their mistakes without impacting patients negatively. 6. provides standard learning situations for everyone.

16. eSimulation in Action 5. allow learning from peers. (model behavior) 4. work on time management and priority setting. 3. allows updating of new information and technology quickly and seamlessly. 2. bridge the student nurse, medical student, new resident, returning to practice employee transition to the workplace.

17. eSimulation in Action And the #1 thing eLearning and eSimulation can do

18. eSimulation in Action 1. improve resuscitation, patient care and patient outcomes!

19. eSimulation in Action eLearning with HeartCode Self-Directed Learning HeartCode: (all AHA approved) ACLS BLS PALS! UMHC used the Actronics system until 2004 and upgraded to Heartcode ACLS. Due to popularity, ACLS use grew and BLS was added in 2008 and PALS added this year.

20. eSimulation in Action HeartCode: Link between “book learning” and simulation. Helps efficiently maintain compliance and competence for otherwise experienced employees that don’t necessarily need live training to maintain a certification.

21. eSimulation in Action 2 Part Process >>> course completion Cognitive-BLS, ACLS, PALS Skills Test with VAM- BLS, ACLS (PALS-Live skill check with AHA PALS Instructor) Receive Course Completion Card (Laerdal is AHA TC and will issue BLS and ACLS Provider cards)

22. eSimulation in Action Benefits to Learner: Self directed learning Shorter than live class Potential availability 24/7 Instant, objective feedback

23. eSimulation in Action Benefits to Organization Reduced costs Clear cost structure Consistent and standardized training Diversifies training options

24. eSimulation in Action BLS Live BLSBLS Online = Skill check BLS HC Hours to complete 3.5-4*2.5 total* (1.5 hr for online part, 1 hr skill check) <1.5 hr average** # Instructors needed 6-83 + 1 non-instructor for check in/check out NONE # Participants trained/session 24/4 hr (48/month) 36/4 hr (72/month) 9/day (180/month potential) *set up and take down/clean up time- 45min- 1 hr **<10 minute clean up of computer room

25. eSimulation in Action

27. pictures

28. eSimulation in Action pictures

29. eSimulation in Action pictures

30. eSimulation in Action pictures

31. eSimulation in Action ACLS Live ACLSACLS HC Hours to complete14-16 hrs Initial* 8-9 hrs Renewal* 6-7 hr avg # Instructors needed 8-16 /2 day Initial class 8 Renewal class NONE # Participants trained/session 24 Initial/month 24 Renewal/month 4/day (208/month potential) *set up and take down/clean up time-2 hr **<10 minute clean up of computer room

32. eSimulation in Action pictures

33. eSimulation in Action PALS Live PALSPALS HC Hours to complete14-16 hrs Initial* 8-9 hrs Renewal* 6-7 hr avg (online portion ) 3 hours ( live skill check) 9-10 hours total # Instructors needed8-16 /2 day Initial class 8 Renewal class NONE -online portion 2-3 skill check # Participants trained/session 24 Initial/month 24 Renewal/month 12/month (12 participants/ 1 skill check/month) *set up and take down/clean up time 2 hr *set up and take down/clean up time-45min- 1 hr

34. eSimulation in Action HEARTCODETHROUGHTHEYEARS 2007200820092010 BLS HCNAStart Nov 2008 94/yr 136 Jan-Sept ACLS HC252/yr273/ yr328/yr 310 Jan-Sept PALS HCNA 12 May-Sept

35. eSimulation in Action Barriers to using HeartCode … (student) Fear of technology Lack of team support found in live classes Frustration

36. eSimulation in Action Barriers to using HeartCode … (institution) Concern about quality of training Equipment and software costs Administration costs

37. eSimulation in Action COSTS Live ClassesHeartCodeOnline + Skill Check BLS $90/student no instructor costs Cost of license no instructor costs Cost of access code no instructor costs $35/ student/skill check ACLS $342/ student/Initial* $210/ student/Renewal Cost of license no instructor costs NA PALS $342/ student/Initial * $210/ student/Renewal Cost of license $25/hour/instructor NA * includes instructor costs at $25/hour/instructor No charge to staff at MUHC- outside participants pay student cost as calculated

38. eSimulation in Action Additional benefits noticed at Missouri University Health Care: Offering multiple opportunities outside the structured classroom staff satisfaction! Address all learning styles Last minute recerts! Critical thinking in a safe environment-teaching environment Can use over and over to review-”practice makes perfect”

39. eSimulation in Action SIMULATION AT MISSOURI UNIVERSITY HEALTH CARE

40. eSimulation in Action At MUHC simulation is collaborative effort to help provide safe and effective patient care. Students New Staff Current Staff

41. eSimulation in Action Missouri University Health Care There are multiple simulation opportunities for our students and staff. Center for Education and Development Skills Lab Shelden Clinical Simulation Center Sinclair School of Nursing Simulation Lab

42. Missouri University Health Care’s Journey… One paw print at a time The beginning was rough…

43. When Sim Man was first purchased, he sat in Linda's shared office for months until they got tired tripping over the boxes. No space had been designated to “keep” Sim Man so the boxes were moved to storage. When finally opened he was already due for an upgrade! The search for a home commenced.

44. eSimulation in Action

46. The first simulation course with CEDrick was an interdisciplinary effort to improve resuscitation. Mock Code Monday

47. eSimulation in Action Mock Code Monday 0730-0900 (46) Interdisciplinary Mock Code practice Internal Medicine Residents Nursing (New and Current Staff) Respiratory Therapists and Respiratory Therapy Students Nursing Students Anesthesia Residents ACLS instructors using ACLS Scenarios Uses simulation manikin in simulated setting Includes debriefing

48. eSimulation in Action Using Simulation for Interdisciplinary Code Blue Training: 2 Year Experience 178 ACLS Professionals -1 ½ hour of Simulated COde Team training (SCOT) Moderately Confident Interpreting rhythms-35% Follow ACLS Protocols-30% Drug Selection-28%

49. eSimulation in Action Conclusions: Lack of confidence among certified ACLS providers. Simulation can be used to foster interdisciplinary teamwork and focus on common educational objectives, thereby reducing duplication of cost and time associated with training. 85% agreed that the simulated code training was useful or extremely useful and would return for more training. Poster Session Presented at IMSH 2010

50. eSimulation in Action Trauma Nursing Update Unit Based Mock Code Classes Introduction of Simulation

53. Partnering Sim Center and SON

54. eSimulation in Action

55. Just as a code team needs both skills and teamwork to work effectively, the different simulation centers and groups are working together collaboratively to meet student and staff needs.

56. eSimulation in Action Purchased Mobile Unit with recording and data collection capabilities

57. eSimulation in Action Pre and Post Evaluation Data Collection

58. Metrics

59. eSimulation in Action

63. 2010 Mock Code Training for Women's and Children’s Hospital (Formerly CRH) Training for Pediatric Transport team Training for the Helicopter Flight team Missouri Psychiatric Center Emergency Response training

64. eSimulation in Action 2010 Missouri Orthopedic Institute training for staff and evaluation of emergency protocols Added Simulation to New Staff Orientation Mock Code Stroke Insitu training for evaluation of ER and Inpatient Stroke protocols Patient and Family Centered Care Model Videos

65. eSimulation in Action Future Plans Increasing Insitu Simulations Increasing Simulation in New Staff Orientation And about a MILLION other requests….

66. eSimulation in Action To sum it up…

67. eSimulation in Action Healthcare providers need to respond to the changes in training requirements, address different learning styles, consider challenging schedules and workloads.

68. Missouri University Health Care’s Journey… One paw print at a time