1. Safety Human Factors Human Factors Infection Control Infection Control Medication Safety Medication Safety Intranet Intranet Latex Allergy Latex Allergy Device Management Device Management Abbott Pump Abbott Pump Hill-Rom Bed Hill-Rom Bed Glucometer Glucometer PCA Pump PCA Pump Quick Signs Quick Signs

2. Clinical Topics Skin and wound care Skin and wound care Ostomy, tubes, and drains Ostomy, tubes, and drains Pain assessment/comfort promotion Pain assessment/comfort promotion Point of care testing verification Point of care testing verification

3. Weekly Schedule: Weeks 2 - 9 Functional Content Review: 4 hours Functional Content Review: 4 hours –Respiratory Management –Tissue Perfusion/Vascular –Tissue Perfusion/Cardiac –Psychosocial/Spiritual –Neurological –Elimination/Nutrition

4. Weekly Schedule: Weeks 2 – 9 Simulation Training to reinforce selected functional focus area: Simulation Training to reinforce selected functional focus area: At least 4 hours/week At least 4 hours/week

5. Weekly Schedule: Week 10 Residency *Testing* Residency *Testing* –Demonstrate competency in randomly selected events through simulation exercises

6. Weekly Schedule: Weeks 11 - 12 Unit- based continuation of residency. Unit- based continuation of residency.

7. Underlying Tenets Five, eight hour days through early weeks of residency program Five, eight hour days through early weeks of residency program Weekly clinical focus on identified functional area Weekly clinical focus on identified functional area Simulations developed from actual clinical practice Simulations developed from actual clinical practice

8. Simulations in Medical/Surgical Residency Selection of Scenarios Selection of Scenarios –Ability to make scenarios effective by incorporating: equipment and processes, equipment and processes, communication and team work, and communication and team work, and medication management. medication management. –Select scenarios that have a potential significant impact on “failure to rescue” conditions/situations.

9. Simulations in Medical- Surgical Specialties Residency Respiratory Respiratory –Moderate sedation and airway management –Chest tube insertion/care –COPD with pneumonia –Tracheotomy care Peripheral Vascular Peripheral Vascular –Heparin protocol/DVT –Blood administration Cardiac Cardiac –Shockable and non-shockable rhythms

10. Simulations in Medical- Surgical Specialties Residency Cardiac (continued) –Acute coronary syndrome –Hypovolemic shock –Tachyrhythms Neurological Neurological –Stroke –Seizure –  ICP –Confused patient/restraints Nutrition/Elimination Nutrition/Elimination –Diabetes –Tight glycemic control –Renal failure

11. Responses from Participants “At the moment when the scenario begins to deteriorate the simulation feels much like an actual crisis on the floors. There is confusion, most of which is related to my own inexperience. Repeated simulations will help build confidence as well as competency.”