Improving Care for Pediatrics Nancy M. Tofil, M.D., M.Ed. October 2011

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Oct 29, 2013 (3 years and 9 months ago)

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Improving Care for Pediatrics

Nancy M.
Tofil
, M.D., M.Ed.

October 2011

Disclosure





I have no conflict of interests to disclose

Overview

0
-
5min



Introduction/Turning Point Slides

5
-
15min


Objectives

15
-
45min


Review Pediatric courses and







opportunities

45
-
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?

1.
0
-
6months

2.
6
-
12months

3.
12
-
18 months

4.
18
-
24 months

5.
2
-
5 years

6.
> 5years

What is your role?

1.
Simulation technologist

2.
Nurse educator

3.
Physician/ Advanced
provider

4.
Administrator

5.
Other

Who is your primary learner?

1.
Nurse

2.
Medical Student

3.
Resident

4.
Staff Physician

5.
EMT

6.
Other

Where is your center located?

1.
Free standing

2.
In hospital

3.
In nursing or allied health
school

4.
In medical school

5.
Other

Which high
-
fidelity pediatric
simulators do you have?

1.
Laerdal
SimBaby

2.
Laerdal SimNewB

3.
METI
Child

4.
Gaumard

5.
More
than
one
type

6.
None yet

What do you feel is the biggest obstacle you face
concerning moving simulation forward at your
institution?

1.
Financial related

2.
Technical knowledge

3.
Time constraints

4.
Hospital support

What is your primary goal from this workshop?

1.
Programming Advice

2.
Ideas for pediatric sim
courses

3.
Strategies to move your
center ahead

4.
Product advice

5.
Obtain new scenarios

6.
Other

Learning Objectives

1.
Discuss the medical/legal environment in the
pediatrics area

2.
Identify issues specific to pediatric care

3.
Describe the history of pediatric simulation

4.
Describe the role of simulation in providing
quality pediatric education

5.
Discuss collaboration with multidisciplinary
leadership

6.
Describe how to plan and implement pediatric
simulation

7.
Define measurable objectives for success

Medical/Legal Environment

1.
Patient safety

2.
Resident duty hours

3.
Transition of responsibility to fellows and
attendings

4.
Nursing students less exposure

5.
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

0
2
4
6
8
10
12
First Year
Second Year
Third Year
Fourth Year
Hours of experience (in thousands)

Years after professional degree

Old
New
1

1.
Clinical
Education


Inefficient

2.
No Debriefing

3.
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
*

Concrete

Experience

Reflective

Observation



Abstract conceptualization


Active experimentation

Debriefing

Relating to actual

situations, developing
rules, algorithms


Practicing

*Kurt Lewen

Simulation

1.
Standardize exposure

2.
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.
Orthopedics

2.
Anesthesia and CRNA

3.
Pharmacy Student

4.
PICU Nursing

5.
Solid Organ Transplant Nursing

6.
Dialysis Nursing

7.
NICU Nursing

“Silo” Courses

Orthopedics


Anesthesia and CRNA


NICU Nursing

1.
Nursing Skills Labs (First 5 Minutes of a Code)

2.
PALS

3.
Geriatrics

4.
NRP

5.
Clinical Assistant

6.
New Hire Nursing Assessment

7.
Sleep Technologists

8.
Nursing Mock Code Orientation

9.
Home Ventilator

10.
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 CASES

1.
Sentinel events

2.
Near misses

3.
Rare events (contrast reactions)

4.
Safety & equipment issues

5.
Requests

6.
Codes

7.
Premature Closure

8.
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

RESOURCES

1.
Online: forms, scenarios, programming, moulage

2.
Internal: staff

3.
Networking

4.
Organizations

5.
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 Agree

nor 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 Solving
1


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 forget

I see and I remember

I do and I understand

Confucius, 551
-
479 BC