If I only knew then what I know now - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

If I only knew then what I know now

Description:

If I only knew then what I know now – PowerPoint PPT presentation

Number of Views:43
Avg rating:3.0/5.0
Slides: 63
Provided by: radfo78
Category:
Tags: ce | com | knew | know | mga | now | ty

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: If I only knew then what I know now


1
Southwestern Virginias Regional Clinical
Simulation Centers
  • If I only knew then what I know now
  • Presented by
  • Cynthia G. Cunningham, MSN, RN

2
June 8, 2005
  • State Council of Higher Education in Virginia
    (SCHEV) and regional nursing programs met to
    explore ways of partnering with public and
    private entities to
  • Maximize the use of scarce resources
  • Address the shortage of nursing faculty
  • Explore alternatives for nursing student clinical
    education

3
THE PARTNERSHIP Collaboration of nursing
educators to develop strategies to address the
shortage
  • Radford University
  • Jefferson College of Health Sciences
  • Wytheville Community College
  • New River Community College
  • Virginia Western Community College
  • Patrick Henry Community College

4
RU SON ASSUMED LEADERSHIP
  • Developed the CSC concept
  • Submitting CSC proposal to SCHEV
  • Proposal was included in the Governors Budget
    for the next biennium
  • Funding for the project was allocated to Radford
    University in July 2006

5
OVERALL GOAL OF THE CSC
  • To alleviate the shortage of nurses in Virginia
    by increasing the capacity of nursing schools to
    enroll students, maximizing use of faculty
    resources, and decreasing competition for scarce
    clinical sites

6
VISION
  • The Clinical Simulation Centers will provide a
    hands-on learning experience in an environment
    that is safe and realistic, producing quality
    nurses with enhanced critical thinking abilities,
    communication skills and collaboration experience

7
THE BUSINESS PLAN
  • History
  • Profile
  • Business Summary
  • Product/Services
  • Industry Analysis
  • Marketing Analysis
  • Organization/Management
  • Financial Section
  • Assumptions
  • Revenue Streams
  • CSC Budgetary Projections
  • Personnel
  • Operating
  • Equipment Lists

8
SIMmares
The renovation
Definition Simulation based disturbing
dreams. Typically occurring between 3am - 5am.
Occasionally may happen during the day.
9
Renovation/Space Planning Team
CSC Director
Facilities Planning and Construction
Laerdal Sales Rep
Education Management Solutions (EMS) Hardware
Design Specialist
Create-a-lab Rep
10
SIMmare 1
  • My renovation team is gone and I dont know what
    I am doing.

11
Renovation team turn over...
  • Laerdal rep decided to change territories
  • Wanted to move back to Texas
  • Education Management Solutions (EMS) rep decided
    traveling was not conducive to a personnel life!
  • Was married within a year
  • Create-a-lab rep decided to start a family
  • Had a bouncing baby boy

Do you think it could be me?!!!!
12
If I knew then what I know now
  • I would have an exit review with any renovation
    team member leaving the project.
  • I would visit more SimCenters and ask more
    questions r/t design
  • I would participate in more SUNs

13
And if necessary .
14
I live on the Lake and have a boat and SeaDoo
  • Great for entertaining ..boating..fishingrelax
    ing...

15
I have two Newfoundlands
  • ..and they are great with children

16
Due renovation team turn-over
  • I ASSuMEd and my new team members ASSuMEd

17
SIMmare 2
  • The control room

CONNECTIVITY
18
If I knew then what I know now
  • I would have clear operational expectations
    central control room separate from SIMroom with
    A/V observation
  • I would include IT in the renovation team
  • I would include SimPhones to connect each
    SimRoom to each control
  • room operating station

19
My SIMteam
RU SON
CSC Director (MSN)
RHEC Site
RU West Site
2 MSNs, 1 IT Specialist 1 Admin Specialist II
2 MSNs, 1 IT Specialist 1 Admin Specialist II
VWCC
PHCC
JCHS
RU
WCC
NRCC
RU
20
SIMmare 4
  • Receiving and Installing 1.9 Million Dollars of
    Equipment

Of course spending was not the nightmare. Receivi
ng, installing and tagging all items gt 5000 and
all IT equipment was!
21
Receiving Equipment - Laerdal
This doesn't look good
Humm
  • Include on-site delivery installation
  • in purchasing agreement

22
Laerdal representative after receiving equipment
Sturgis DREAMS Russell returns to Virginia
Purchasing Agreement
  • manikins, room furnishings, task trainers,
    virtual IV

23
Installing Equipment
  • Room set-ups per site
  • 1 Med/Surg SimRoom
  • 1 ICU SimRoom
  • 1OB SimRoom
  • 1 Pediatric SimRoom
  • 2 Exam Rooms
  • 1 Multipurpose classroom with 3-5 patient beds
  • Simulation Apartment
  • Computer Classroom
  • Manikin Assembly
  • 4 SimMan
  • 4 SimBaby
  • 2 Nursing 2 ALS Annes
  • 2 MegaCode 2 Nursing Kellys
  • 2 Nursing 2 MegaCode Kids
  • 2 Nursing Baby
  • 2 Noelle
  • 4 Adult 2 Peds Virtual IV,
  • .

24
Installing Equipment - Laerdal
Ouch! SimMan kicked me!
SimMan, try to behave yourself
25
Laerdal representative after installation of
equipment
Sturgis DREAMING My new territory TEXAS!
26
Installing A/V IT equipment
  • Room set-up x 7 per site
  • 2 Pan Tilt Zoom Cameras
  • Microphone
  • Cabling between room and control room to connect
    (cat 5, extender boxes)
  • Cabling between room and server room (A/V
    connections)
  • Cabling between control room and server room
  • Server Room
  • 2 DVRs
  • 2 computers to control DVR
  • 1 computer to manage video
  • 1 SQL server (database)
  • 1 IIS server (web)
  • 1 Quantum Tape Library
  • 1 SNAP Server for video storage

27
Installing A/V IT equipment
28
If I knew then what I know now
  • I would hire 1 IT specialist and 5 MSNs
  • Rationale for one IT specialist
  • A bored IT leads to a gone IT
  • Most everything can be fixed remotely
  • Standardization between sites
  • Rationale for Additional MSN
  • Increased capacity of students served (450
    students/semester)
  • Increased volume of scenarios produced
  • Back-up for staffing due to illness/surgery, time
    off.

29
SIMmare 5
  • Manikin responses are not in sync with monitor
    readings or scenario program

Another CONNECTIVITY Problem
30
Nine Pin Problem
  • SOLUTION
  • Pull nine-pin cable through wall/ceiling and
    directly connect to laptop, i.e., by passing the
    rose boxes.
  • PROBLEM
  • Cable extender box nine pin connection
    transmission delays between control room and
    manikin.
  • Manikin pulses and heart rate did not correlate
    with programmed settings and monitor waveforms
    (EKG, Pulse)

31
If I knew then what I know now
  • I would request that integrating equipment be
    tested with the manikin system prior to purchase
    or include a contingency plan for beta testing in
    the purchasing agreement

32
CONTROL ROOM
Imagine No Monitors
Imagine No plan to connect manikin to the Laptop
33
MED/SURG ROOM
34
OB ROOM
35
PEDIATRIC ROOM
36
INTENSIVE CARE ROOM
37
DEBRIEFING ROOM
38
Lessons Learned Over TIME
  • Scenario Development
  • Revenue Planning
  • Student driven
  • Organization
  • Admission ticket
  • Incorporate pre/post encounter evaluation and add
    NCLEX ? to pre
  • Reinforce concepts/nursing process included in
    admission ticket, pre-encounter, and scenario
  • Incorporate NCLEX ?s
  • Start early
  • Partner and/or barter with as many organizations
    as possible
  • Charge fee for unused time
  • Block scheduling

Student Preparation Evaluation
Partnering/Bartering
Organized Debriefing
Scheduling
39
Curriculum Integration
  • Orientation
  • Boot-camps
  • Fundamental
  • Front-loading
  • Standardized patient encounters
  • Mental health
  • Assessment, HP
  • Follow course syllabus when choosing scenario

40
Consider fidelity
  • Choose the right manikin/SP for the simulation
  • If equipment is needed actually use the equipment
    headwall O2/suctioning, IV pump, 12-lead.
  • Include supporting documentation SIMChart
  • Suspend disbelief do not ask students to
    pretend or use phrases like if you were taking
    care of a real patient.you would..

41
Student Driven NOT Operator Driven
  • Student intervention or non-intervention dictates
    manikin action
  • All vocals are pre-recorded
  • Use handlers for all actions that are not tied to
    time or sequencing
  • If sequencing is important, incorporate
    standardized cues (vocal, manikin action)

42
Lessons Learned
Scenario Development Process
  • SCENARIO DEVELOPMENT REVIEW STORAGE
  • Standardized event menus
  • Indicate events with v. if vocal is attached
  • Lab reports, xrays,as pdf files to display on
    pt. monitor
  • Scenarios reviewed revised every summer to
    insure best practice

43
(No Transcript)
44
Lessons Learned
Scenario Storage
  • SCENARIO DEVELOPMENT REVIEW STORAGE
  • Shared scenario storage system
  • FinalSim houses all up-dated scenarios - batch
    file runs every night to load to Laerdal
    computers

45
(No Transcript)
46
(No Transcript)
47
(No Transcript)
48
(No Transcript)
49
(No Transcript)
50
(No Transcript)
51
(No Transcript)
52
Lessons Learned
Preparation-Evaluation-Debriefing Putting it all
Together
  • Assessing Preparedness
  • Solutions to Assessing Preparedness
  • Need better criteria to assess preparedness.
  • Too much information in post encounter evaluation
  • Information is fragmented inconsistent flow
    from prep work through post encounter evaluation.
  • All scenarios have an admission ticket student
    must complete the admission ticket to participate
    in the simulation
  • Incorporate a pre-encounter and post-encounter
    student questionnaires
  • Incorporate nursing process in pre/post encounter
    evaluation
  • Incorporate NCLEX question in pre-encounter and
    into debriefing

Data Collection
Solutions to Data Collection
The bigger picture
Solution to making a bigger impact
53
(No Transcript)
54
(No Transcript)
55
Lessons Learned
Debriefing
  • Student driven
  • Incorporate admission ticket questions,
    pre-encounter into discussion
  • Video review
  • NCLEX question review

56
A client admitted with a diagnosis of chronic
atrial fibrillation is on a daily dose of
warfarin (Coumadin) 2.5 mg. The serum
international normalized ratio (INR) is 4.7.
What intervention should the nurse be prepared to
initiate?
  1. Observe the client for a possibility of an
    embolic event.
  2. Have a partial prothrombin time (PTT) drawn to
    completely evaluate the level of anticoagulation.
  3. Prepare to administer protamine sulfate.
  4. Monitor the client for signs of bleeding.

57
1. A client admitted with a diagnosis of chronic
atrial fibrillation is on a daily dose of
warfarin (Coumadin) 2.5 mg. The serum
international normalized ratio (INR) is 4.7.
What intervention should the nurse be prepared to
initiate?
  • Incorrect. If the client were at risk for an
    embolism, the INR would be very low, reflecting
    inadequate anticoagulation.
  • Incorrect. PTT evaluates anticoagulation levels
    as a result of heparin, not warfarin.
  • Incorrect. Protamine sulfate is the antidote for
    heparin, not warfarin.
  • Correct. The level of anticoagulation, as
    reflected by the INR, is too high and the client
    is at risk for bleeding. The serum INR is done
    to reflect the effectiveness of oral
    anticoagulants, especially warfarin. The normal
    value is 2.0-3.0 for clients on anticoagulation
    therapy.
  • Test-Taking Tip Because the drug is a
    anticoagulant, choose the assessment type of
    answer for the one most related to anticoagulant
    therapy. Eliminate answers 2 and 3 since r/t
    heparin.

58
Lessons Learned
Evaluation
  • RAGE
  • Nursing Process Driven
  • Medication error reporting
  • Curriculum integration questions

59
(No Transcript)
60
(No Transcript)
61
(No Transcript)
62
Any questions?
About PowerShow.com