Secrets of a

Successful

Simulation LabLindsey Sabatini MSN, RN

Simulation lab coordinator

Jaye Henderson MSN, RN

Clinical Instructor

Disclosure

Objectives

• Participants planning to begin a simulation lab will be

able to identify key components needed to launch a new

lab.

• Participants will be able to distinguish between effective

and infective debriefing strategies.

• Participants with an existing simulation lab will be able to

describe methods for implementing more complex

techniques in developing an EMR, multiple patient

simulations and faculty training.

Physical Structure

• Simulation lab is 5,152 square feet

• 5 patient rooms

• 4 debriefing rooms

• 2 offices

• Control hallway

• Store room

• 6 CAE mannequins • 1 iStan, 3 METIman, 1 PediaSIM and 1 BabySIM

• http://caehealthcare.com/eng/patient-simulators

• Low fidelity simulation labs 12,835 square feet

• 2 low fidelity “skills labs’

• 2 health assessment labs

Funding

• Initial funding

• 1.9 million in initial cost of mannequins and equipment

• Purchased 5 mannequins, 100 SCE’s, MUSE, learning space

and equipment (beds, IV pumps etc.)

• Donations from local hospitals and individual donors

• Maintenance

• Warranties

• Yearly budget

• Full time and adjunct instructors

What a simulation looks like

• Clinical section of 8 students

• Ticket to sim-Preparation questions

• Pre-quiz

• Pre-brief

• Simulation

• Debrief

• homework

What a simulation looks like

• Broken into 3 shifts of 2/3 students in each

• Each shift must assign 4 roles

• Primary nurse

• Medication nurse

• Education nurse

• Documentation nurse

What a simulation looks like

Criteria Novice Competent: Proficient

Participation 0 to 1 point

Dress code not

followed.

Does not act

professional in the

simulation

experience. Exercises

unsafe nursing

practice.

Does not participate

in debriefing.

2 to 3 points

Participates

minimally in

debriefing and during

the actual simulation

experience.

4 to 5 points

Follows dress code.

Acts professional

during the simulation.

Takes on role

assigned and helps

others as indicated.

Exercises safe

nursing practice and

applies accurate

nursing knowledge

appropriate for skill

level. Actively

participates in

debriefing.

Post Simulation

Assignment

0 to 1 point

Assignment mostly

inaccurate and/or not

turned in.

2 to 3 points

There are

inaccuracies and/or

the assignment turned

in late.

4 to 5 points

Assignment is

accurate and turned

in on time.

Total

/10 possible points

Levels of Achievement in Simulation Lab

Staffing

• Simulation Coordinator

• IT support

• 7 full time faculty assisting in simulation lab

• 4 adjunct instructors

• Independent Study Students

• Work Study

Who do we serve?

• 400 students in the Eleanor Mann school of nursing

program

• 1st semester

• 2 simulations in fundamentals

• Hip replacement

• CHF

• 2nd semester

• 3 simulations in Med/Surg

• Ileus, COPD and blood transfusion

Who do we serve?

• 3rd semester

• 3 simulations in pediatrics

• Dehydration, appendicitis and pertussis

• 4th semester

• 2 simulation in critical care

• CHF and sepsis

• 1 multi patient simulation in immersion

• Shift 1: Cocaine OD, Hospice and GI bleed

• Shift 2: ETOH withdrawal, DKA, Hyperemesis Gravidarum

Who do we serve?

• Local Hospitals

• Multi-disciplinary

• Athletic Trainers

What we do well!

• Run A LOT of simulations!

• 145 this semester

• Full time IT support

• Scheduling

• Organization

• Orientation of staff assisting in simulation lab

• Learning space/MUSE, SCE’s

• Incorporate low fidelity simulated experience into all skills labs

What we do well!

Identify: State name, title and unit

Situation: Patient’s Name & Room Number

Admitting Dr: Weight:

Background:

Admission diagnosis and date:

Allergies: Code status:

Assessment:

Vital Signs:

General Appearance:

Cardiovascular:

Respiratory:

GI:

GU:

Extremities:

Skin:

Neurological:

IV’s:

Labs/X-ray:

Fall Risk:

Pain:

I & O

Psychosocial

Recommendations: what do you think would be helpful or needs to be done:

Patient care goals ( identify any changes made)

New orders since you came on duty

Consults done, scheduled or needs to be ordered

Tests/treatments done, scheduled, or needs to be ordered

Discharge need

Read Back: Restate any recommendations made by the staff nurse or clinical instructor

EMSON Hospital

ISBARR Report Sheet

Scheduling

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

1 2 3 4 5

Research Day Peds-012-Dehydration 830-1230

Peds-012-Appy 1230-330

Peds-012-Baby-830-1130 LS=10 hrs BW=4 hrs

RP=4 hrs KW=4 hrs

LF=4 hrs MS=3 hrs

JH=6 hrs

6 7 8 9 10 11 12

IM-004-830-1230

(LS/CH/BW/LF/RP)

Peds 007-Dehydration-830-1130 Peds 007-Appy-830-1130 Peds 007-Baby-830-1130 LS=7 hrs CH=4 hrs

RP=4 hrs BW=4 hrs

LF=4 hrs MS=3 hrs

JH=6 hrs BM=9 hrs

13 14 15 16 17 18 19

IM 005-830-1230

(AL/BW/KW/LF/RP)

IM-006-1-5

(LS/AL/KW/LF/RP)

MS-1/2/3-Blood-1-4 Peds 008-Dehydration-830-1130 Peds 008-Appy-830-1130 Peds 008-Baby-830-1130 LS=14 hrs CH=3 hrs

RP=8 hrs KW=8 hrs

LF=4 hrs MS=3 hrs

JH=6 hrs GH=3 hrs

AL=8 hrs BW=4 hrs

20 21 22 23 LS=runner=8 hrs 24 25 26

IM 007-830-1230

(CH/BW/KW/LF/RP)

CC-002-Sepsis-1-4

MS-4/5/6-Blood-1-4 FO-1 (AM)/2-CHF-8-11

FO-3/4-CHF-11-2

FO-5/6-CHF-2-5

Peds 009-Dehydration-830-1130

CC-003-Sepsis-9-12

CC-006-Sepsis-1-4

Peds 009-Appy-830-1130

CC-004-Sepsis-1-4

FO-8/9-CHF-8-11

Peds 009-Baby-830-1130

CC-001-Sepsis-9-12

CC-005-Sepsis-1-4

LS=20 hrs CH=13 hrs

JH=6 hours KW=10 hrs

GH=12 hrs BW-10 hrs

MS=6 hrs LF=4 hrs

RP=4 hrs AM= 3 hrs

27 28 29 30

HPSN Conference

Make Up Sim 10-1

(Ann + Cathy +BJ)

HPSN Conference

FO-7-CHF-9-12

HPSN Conference

FO-11 (AM)/12-CHF-9-12

Totals on May 3rd

April 2014

IT

Computer Support Specialist, Epley Center

• Oversee simulations

• Coordinate simulation events and room setup with simulation staff.

• Run simulations for faculty, staff and students

• Assist in train the trainer classes

• Data collection using approved software and student/facility evaluation to be maintained when applied to simulation courses.

• Center Promotional Support

• Equipment and Facility Maintenance• Manage maintenance of facilities and equipment

• Make certain that necessary supplies and equipment are available when needed

• Maintain required inventory of supplies and equipment

• Adhere to preventive maintenance schedules for various equipment

• Manage vendor relations to assure that equipment is maintained in optimal condition

• Obtain needed repairs in timely manner

• IT support for the center

Challenges

• Funding/maintenance

• Staffing

• Scheduling of students

• Changes in the layout/technical details of lab

• Phone system

• Video cameras in debriefing rooms

• Control hallway dividers/separate control rooms

• Call light system

Pre-briefing

• Pre-briefing

• Student thoughts

• “I've learned more in the last 10 minutes than I have the entire

semester.”

• “It builds our confidence and allows us to focus on the learning

experience instead of the equipment.”

Pre-Briefing

Pre-briefing

Pre-briefing (after quiz)

• Why simulation?

• Cerner video on blackboard sim lab site (first sim of each semester)

• Manikin

• Student’s CAN: use IV’s, insert NGT, do CPR, turn patients onto side.

• Student’s CANNOT: give injections into manikin (injection pad in each room), give pills into mouth

• Med machine

• Go over log on, override and witness log ins

• Phone system

• Operator’s number: they can call ANYONE they need to . . . provider, family, pharmacy, nursing supervisor etc!

• Supply cabinet

• Pumps: Alaris or Plum

• Cerner in room

• Should already be logged onto patient

Why Debrief?

• Debriefing is the most important element of high fidelity

simulation (Issenberg, McGaphie, Petrusa, Lee, Gordon,

& Scalese, 2005).

• Clinical knowledge only increases with a simulated

experience when students are exposed to a guided

reflective debriefing (Shinnick, Woo, Horwich, &

Steadman, 2011)

Debriefing

• Setting the tone

• Avoid disappointed or angry body language

• Don’t use position of authority to set the “instructor is

always right” tone

• Create trusting environment

• Allow students to lead the discussion

Debriefing

• Affective debriefing

• Don’t forget to talk about feelings

• Going beyond discussing what happened in the scenario and

addressing how the student felt about the simulation is

important

• (Lavoie, Pepin, & Boyer, 2013)

Debriefing

Debriefing

• Examples based on Gibbs Reflective Cycle

• Description:

• Please describe what you did in the scenario?

• Feelings:

• How did you feel in the simulation at that point?

Debriefing

• Evaluation:

• What did you do well?

• Analysis:

• How do you perceive the situation in the team?

Debriefing

• Conclusion:

• Were there other resources you could have used?

• Action plan:

• If this situation occurs in the future, what would you do?

Needs Improvement Great Job Hands On Practice

Group 1

Group 2

Group 3

EMSON Hospital

Debriefing Notes

Debriefing

Debriefing

EMR

• Since the passing of the HITECH act, electronic medical

records (EMRs) are the standard in patient

documentation.

• The opportunity to practice electronic documentation is

limited in most clinical settings; therefore it is important

to have an environment in which students can practice

this skill.

• (Curry, 2011)

EMR

Multi-patient simulation

• Why?

• Multi patient simulations allows students to transition into

practice by learning to manage a patient assignment.

• They get to practice

• Prioritization

• Delegation

• A realistic hospital experience

• (Chunta & Edwards, 2013)

Multi-patient simulation

Multi patient simulation in immersion

• Shift 1: Cocaine OD, GI Bleed & Hospice

• Shift 2: ETOH withdrawal, DKA &

Hyperemesis Gravidarum

Multi-patient simulation

• Multi patient simulation in immersion

• Shift 1: Cocaine OD, DKA & Hospice

• Shift 2: ETOH withdrawal, GI Bleed &

Hyperemesis Gravidarum

Faculty training

• Orientation

• “Homework” for simulation faculty

• Team meetings mid-semester

Orientation

1:00pm Introductions

1:15pm Simulation Schedule

Review of Program wide Simulation

• 145 sims-how many each semester

• Manikins

• Layout

• Debriefing rooms

• Control hallway

2:00pm Components of Student participation

• Contract that is signed for J1/J2

• Expectations

• Counseling records

• Grading tools (20 points per simulation experience)

• Pre-quiz

• Students homework

• Blackboard

• Independent study students

• Make up Sim April 28th 10-1

2:30pm Break

2:40pm Debriefing

• PowerPoint

3:15pm Tour of Simulation Center

• How to turn manikins on

• Lap top connection

• TV/monitor

• Hands on assessment

3:50pm Evaluations/Homework

EMSON

Agenda for Faculty Simulation Orientation

January 8, 2014 1-4pm

1:00pm Introductions

1:15pm Simulation Schedule

Review of Program wide Simulation

• 145 sims-how many each semester

• Manikins

• Layout

• Debriefing rooms

• Control hallway

2:00pm Components of Student participation

• Contract that is signed for J1/J2

• Expectations

• Counseling records

• Grading tools (20 points per simulation experience)

• Pre-quiz

• Students homework

• Blackboard

• Independent study students

• Make up Sim April 28th 10-1

2:30pm Break

2:40pm Debriefing

• PowerPoint

3:15pm Tour of Simulation Center

• How to turn manikins on

• Lap top connection

• TV/monitor

• Hands on assessment

3:50pm Evaluations/Homework

http://collaborate.uw.edu/faculty-development/teaching-with-simulation/teaching-with-simulation.html-0

Fidelis Maternal Fetal Simulator

Fidelis Maternal Fetal Simulator

CAE Fidelis Maternal Fetal Simulator Simulated Clinical Experiences for Childbirth Training

• A normal delivery

• An instrumental vaginal delivery

• Fetal tachycardia due to maternal pyrexia

• Breech delivery

• Fetal central nervous system depression by narcotics given to the mother

• Shoulder dystocia

• Major post-partum hemorrhage due to uterine atony

• Maternal cardio-respiratory arrest

• Eclampsia

• Umbilical cord prolapse

Fidelis Maternal Fetal Simulator

Student comments

• Knowing when to call in help from a physician or a pharmacist or supervisor when I need an answer to a question.

• Good experience with assessment skills and medication preparation.

• I feel that I improved on my critical thinking skills as well as establishing how I go through my nursing process and establishing a routine in administering nursing care.

• Prioritizing for the patient's needs!

• how to work as a team with fellow students, IVs, how to read monitors, heart sounds. In earlier semesters, medication administration.

References

• Chunta, K. (2013). Multiple-Patient Simulation to Transition Students to ClincalPractice. Clinical Simulation in Nursing, 9 (11), 491-496.

• Curry, D. (2011). Selection and implementation of a simulated electronic medical record (EMR) in a nursing skills lab. Journal of Educational Technology Systems, 39(2), 213-218.

• Husebo, S., Dieckmann, P., Rystedt, J., et al. (2013). The Relationship Between Facilitators' Questions and the level of Reflection in Postsimulation Debriefing. Society for Simulation in Healthcare, 8 (3), 135-142.

• Issenberg, S., McGaphie, W., Petrusa, E., Gordon, D.,& Scalese, R. (2005) Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Medical Teacher, 27 (1), 10-28.

• Lavoie, P., Pepin, J., & Boyer, L. (2013). Reflective debriefing to promote novice nurses’ clinical judgment after high-fidelity simulation: A pilot test. Dynamics, 24 (4), 36-41.

• Shinnick, M. Woo, M., Horwich, T. & Steadman, R. (2011). Debriefing: The most important component in simulation? Clinical Simulation in Nursing 7 (3) e105-e111.