1. Welcome Laerdal SUN 2009 Dallas, Texas

2. Brief Introduction Susan Lucot, MSN, RN – Nurse Educator, SimMedical Laura Mosesso – Project Manager, SimMedical

3. Agenda Tell us about you! – Audience Response System What are Response Teams and Initial Providers Simulation Session Debriefing Exercise Curriculum Exercise Product Review Question and Answer Session

4. What is your primary role at your facility? 1.Clinician 2.Clinical Educator 3.Educator (Not clinically active) 4.Administrator 5.Simulation Operator 6.Other

5. If you are a clinician, tell us more! 1.RN 2.MD 3.Respiratory Therapist 4.Paramedic / EMT 5.Other

6. Why are you here? Are you interested in… 1.Rapid response team training 2.Initial in-hospital responder training (prior to code team arrival) 3.Learning what others are doing 4.Looking for ways to improve what you are already doing

7. What are you currently doing for team or initial responder training? 1.Course material only 2.Course material and simulation sessions 3.Simulation sessions only 4.Not teaching

8. 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 those errors are associated with communication issues

9. 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.

10. 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

11. WHAT is Rapid Response Team Training? Also known as Crisis Team Training (CTT), Medical Emergency Response Team (MET), Code Team…. – Teams of clinicians rush to a patients location whenever a clinician feels the patients 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 typically report reductions in the number of cardiac arrests, unplanned transfers to the ICU and in some cases, overall mortality rates

12. WHY Rapid Response Team Training? The Joint Commission – 2008 National Patient Safety Goals Goal 16: Improve recognition and response to changes in a patients condition. o 16A: 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 patients condition appears to be worsening

13. 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

14. 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

15. WHY Initial Responder training? Critical Incidents: High percentage outside critical care areas Survival highly dependent on Initial or First Responders Multiple factors influencing outcomes include: – Patient co-morbidities and initial cardiac rhythm – Duration of incident and time to defibrillation Need for rapid and effective BLS and ACLS

16. Importance for sufficiently trained personnel – Perform effective BLS – Initiate early intervention and defibrillation if needed AED utilization – Less intimidating – Support rapid defibrillation WHY Initial Responder training?

17. 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?

18. How do you run scenarios? 1.On the fly 2.Programmed but always tweaking 3.Preprogrammed *may select more than one answer

19. How do you debrief? *may select more than one answer 1.Record video 2.Use checklists 3.Collect data 4.Utilize Laerdal software and hardware 5.Other

20. Simulation Scenario 3 volunteers needed 3-5 minute scenario Observers - please take notes to debrief as you would normally at your organization Volunteer scenario orientation – Setting – Equipment – Roles

21. Patient Report Location: Non-Monitored Bed Unit Patient: William Roberts Patient Information: 82 year old male post- operative for hernia repair Past Medical History: Myocardial Infarction (4 years ago) Meds: Aspirin daily

22. Debriefing Exercise Share 1-2 of your debriefing points Compare and contrast debriefing points

23. Problem with current debriefing methods (pick your greatest pain) 1.Too many instructors debriefing differently 2.Ineffective assessment tools 3.Lack of standard debriefing points 4.Inconsistent scenario progression

24. Scoring Tools Exercise Think back to the scenario…consider the following: – Would these tools have helped with the assessment? – Do you feel the tools would help relate the debriefing to scenario objectives? – Would these tools provide standardization to the instructor community? – Is it important to assess the same way with each training session?

25. Scoring Tools Exercise Standard assessment tools help to – Keep instructors focused – Clearly outline learning objectives – Organize time driven interventions – Gather valid research data These are all common problems in simulation-based training today!

26. What is a Course? Based on the above information, please share your thoughts on what would go into each category. COURSE Before ClassDuring ClassAfter Class

27. What is a course? COURSE Before ClassDuring ClassAfter Class Participant content Instructor content Lecture Simulation Debriefing Assessments

28. SimMedical Located in Pittsburgh, Pennsylvania A company of University of Pittsburgh Medical Center (UPMC) Shares the tools and operational best practices established over the past 14 years at the University of Pittsburghs Peter M. Winter Institute for Simulation, Education and Research (WISER) – WISER is a state-of-the-art simulation training and research facility serving the University of Pittsburgh and UPMC

29. SimMedical Delivering comprehensive, realistic and effective simulation-based training is at the core of the SimMedical mission Established track record of serving regional, national, and international clients Services include: – Simulation-based curricula / courseware – Consulting – Training – Web-based simulation information management system (SIMS)

30. Partnerships SimMedical, in partnership with Laerdal Medical, is pioneering simulation-based education 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

31. What is SimMedicals The First 5 Minutes® Course? 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.

32. What is SimMedicals The First 5 Minutes® Course? 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 teams arrival – Part of a hospital quality patient safety program – Meets regulatory requirements

33. What is SimMedicals Rapid Response Team Training Course? Simulation-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

34. What is SimMedicals Rapid Response Team Training Course? Why? – Promotes the fundamentals of teamwork – Emphasis on communication – Strong focus on the importance of practice – Part of a hospital quality patient safety program – Meets regulatory requirements – Developed by Michael DeVita, MD International leader in rapid response systems and simulation training Current President, Society for Simulation in Healthcare

35. SimMedical Courseware – Solutions Focused Full suite of structured materials - including didactic materials, quizzes, surveys, evaluations, scenarios, and debriefing tools Assists with the didactic presentation, the product contains in- depth instructor actions to assist in teaching For the Instructor Includes Participant Guides – individual workbooks for each participant, along with supplemental learning aids For the Participant Supports all aspects of simulation by including pre-programmed scenarios, detailed room setup guides, equipment lists, and supplemental materials For the Simulation Operations Staff

36. Courseware