Pediatric Simulation Center Annual Report 2016 Ross, RN, ECMO Paul ... • The Well Baby simulation...

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Pediatric Simulation Center Annual Report 2016

Transcript of Pediatric Simulation Center Annual Report 2016 Ross, RN, ECMO Paul ... • The Well Baby simulation...

Page 1: Pediatric Simulation Center Annual Report 2016 Ross, RN, ECMO Paul ... • The Well Baby simulation course started in September 2016 and is done ... including the role of the Pediatric

Pediatric Simulation Center

Annual Report 2016

Page 2: Pediatric Simulation Center Annual Report 2016 Ross, RN, ECMO Paul ... • The Well Baby simulation course started in September 2016 and is done ... including the role of the Pediatric

Faculty & Staff

Medical DirectorNancy M. Tofil, MD, MEd

Medical Co-DirectorChrystal Rutledge, MD

Nurse EducatorsJ. Lynn Zinkan, MPH, RN, CPEN, CHSECarrie Norwood, BSN, RN, CPNKandi Wise, BSN, RN

Director, Simulation ResearchStacy Gaither, BSN, RN

Simulation TechnologistMatthew Seabrooke

Support StaffAndrea R. Benz

We would like to extend a special thanksto Dr. Nathan Swinger for all the time andeffort he has dedicated to improve theknowledge and training of students, residents and staff over the last two years.

Adjunct Faculty Steve Baldwin, MD, Pediatric EMJennifer Beall, Pharm-DKim Benner, Pharm-DDavid Bernard, MD, Pediatric EMShaundra Blakemore, MD, Pediatric EMAmy Cameron, RD, NutritionCarl Coghill, MD, Neonatology Jerry Cox, MD, Pediatric AnesthesiologyBrenda Denson, Pharm-DCandice Dye, MD, General PediatricsLeigh Hardy, RD, NutritionMegan Hofto, MD, General PediatricsDeeAnne Jackson, MD, General PediatricsChris Jolliffe, RN, Sexual Assault Nurse ExaminerCollin King, MD, Pediatric AnesthesiologyDebbie Laney, RN, ECMOJeannine Maclin, MD, Pediatric GIPaula Midyette, RN, CVICUTraci Morgan, CRNP, CVICULauren Nassetta, MD, HospitalistSarah Novara, MD, Pediatric NeurologyTammy Pope, BSN, RN, RNCLeslie Rhodes, MD, Pediatric Cardiology/PICUJenny Ross, RN, ECMOPaul Scalici, MD, General Pediatrics/HospitalistMichael Stalvey, MD, Pediatric EndocrinologyNathan Swinger, MD, PICUBrad Troxler, MD, Pediatric Pulmonology Kristen Waddell, CRNP, PICUSusan Walley, MD, HospitalistMarjorie Lee White, MD, Pediatric EMLindy Winter, MD, NeonatologyMary Worthington, Pharm-DMegan Yanik, MD, Pediatric Nephrology

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Yearly SummaryIn 2016, the Pediatric Simulation Center celebrated its 8th year and 48,000th learner.

Accreditation

Supporting Hospital Initiatives

The Center continues to integrate educational programs and training that supports the Children’s of Alabama Solutions for Patient Safety (SPS) Collaborative. Our Quest is to focus on skills, knowledge, and attitudes necessary to eliminate medical harm to our patients.

The Simulation Center emphasizes patient safety and quality with every learner, course, and interaction.

• Participate in the Solutions for Patient Safety (SPS) collaborative and other CHA quality initiatives.

• Piloted a course to improve the use and recognition of error prevention behaviors

• New nurse graduate program introduces the concept of high reliability and reinforces safety behavior

.

The Pediatric Simulation Center is proud to announce our recognition as an accredited center by the Society for Simulation in Healthcare in Research, Teaching/Education, and Systems Integration. This milestone was obtained in cooperation with UAB as a simulation consortium.

• Clinical assistant course focuses on collaboration, communication, and safety

• Patient scenarios based on real safety issues

• Promote the use of the WHO handwashing guidelines by all simulation participants

• Mock codes to improve systems issues

• Inclusion of mass transfusion protocol drills into mock codes

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Improving Patient Outcomes• Primary Care simulation is a new course offered to all interns during their Primary Care

Immersion week with Dr. Candice Dye. It focuses on a teenage interaction utilizing a standardized patient. It was funded with a UAB Department of Pediatrics Founders Fund Grant.

• Pediatric Neurology simulation is a course offered twice a month to residents on both the Neurology and PICU rotations. The course director is Dr. Sarah Novara. It focuses on the emergency care of an acute neurologic problem. It was also funded with a UAB Department of Pediatrics Founders Fund Grant.

• The Pediatric Hematology/Oncology fellowship directors, Drs. Kimberly Whalen and Anna Xavier, developed and taught a half day course focusing on delivering bad news in the context of hematology/oncology scenarios. All of the Hem/Onc fellows participated. Standardized patients were used to improve realism.

• The Well Baby simulation course started in September 2016 and is done in situ in the Well Baby Nursery 6th floor WIC monthly. This is an interdisciplinary course focusing on nurses and pediatric interns in the Well Baby Nursery. Department of Pediatrics Founders Fund Grant has funded the project with Dr. DeeAnne Jackson and Dr. Kristine Sawyer as the Principal Investigators.

• In 2016, four simulation scenarios were added to the Continuous Renal Replacement Therapy (CRRT) beginner and refresher courses in hopes to enhance the training. Participants get hands on experience trouble shooting common pump problems, while having an actual simulated patient to assess. With this ability to practice in a hands on manner, the learners will hopefully gain muscle memory and have better retention. Since participants may go months or years without actually taking care of a patient on CRRT, we feel realistic training is important.

We continue to partner with the UAB Department of Engineering working closely with biomedical engineering students. Over the summer we developed the third prototype for a pediatric capillary refill model. Intellectual property right forms have been filed. Currently we are working on an anterior fontanelle model for our newborn simulator.

Left: Biomedical engineering students work on creating an anterior fontanelle model.

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Offering Quality Programs

In 2016, the Pediatric Simulation Center saw 5,562 learners and facilitated 8,699 learner hours of simulation. Throughout the year, the Center conducted:

• 701 simulation sessions

• 1017 hours of simulation

• 18 Mock Codes / 6 Mock Traumas

• 20 sessions for New Graduate nurses

• 48 family education simulations

• 18 Neonatal Resuscitation simulations

• 15 Nursing Orientation simulations

• 6 Anesthesia simulations

• 13 PALS simulations

• 14 ECMO simulations

• 28 Error Prevention simulations

In 2016, over 850 staff members were trained in the First Five Minutes of a Code including specialty care clinics, radiology and all acute care areas.

• Nurses and ancillary staff participate in training every six months through annual nursing skills lab and in situ training.

• A video was added to this training so learners can watch an ideal code situation then practice what they have seen.

• The staff trains to do high quality CPR including use of a backboard, minimizing interruptions in chest compressions, connecting patient to defibrillator/monitor using quick combo pads, the importance of someone being the charter/announcer, and preparing the first dose of epinephrine and including that it is ready in their quick SBAR Handoff to code team leader.

• Through mock code evaluations, we have seen a decrease in our time to CPR, first dose of epinephrine, and increased use of backboard, which we believe is partly attributable to this training.

Surgeons and nurses gain hands on experience with ECMO emergencies.

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RN (2442)MD (126)Resident (1092)Respiratory Therapy (134)Clinical Assistant (88)Pharmacist (83)Patient & Family (101)Radiology Technologist (45)PT / OT (52)Registered Dietician (1)Lab (3)Chaplain (10)Dental (1)Transport (2)Pharmacy Technician (35)Social Work (4)

Improving the Care We Provide

Our In-House Learners in 2016*

*Numbers do not include students.

Our mission is to integrate simulation throughout the hospital in a structured learning environment to promote excellence in clinical care, patient safety, and education for all pediatric healthcare practitioners and teams.

Our vision is to focus on interprofessionaleducation, as well as patient and family education, which furthers the Center’s impact and helps ensure safe and quality care for our patients.

• In 2016, we encountered 15 different types of internal(within Children’s of Alabama and UAB) learners including patient family members.

• We provided training for 2,904 internal staff members.

• 101 patient family members attended simulation to practice tracheostomy and/or home ventilator emergencies prior to discharge.

Residents care for a pediatric patient.

Page 7: Pediatric Simulation Center Annual Report 2016 Ross, RN, ECMO Paul ... • The Well Baby simulation course started in September 2016 and is done ... including the role of the Pediatric

Educating

Future CliniciansIn 2016, we educated 1,246 students and conducted:

• 49 medical student simulations

• 3 nursing student simulations

• 9 courses for pharmacy students

The Center mentored 4 third year medical students during their two month Scholarly Activity Block and 13 fourth year medical students during two and four week elective periods. We also mentored 10 engineering students (biomedical and electrical).

Medical Students (1007)

Nursing Students (18)

Pharmacy Students (218)

High School Students (12)

Respiratory Therapy Students (3)

Residents practice effective CPR.

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Serving the

Community

Children’s of Alabama Community Hospital Education Simulation (COACHES) Program

In 2016, through a generous donation from Dr. Joe and Cornelia LaRussa, the COACHES Program was able to fully come to fruition. This program aims to utilize simulation in a structured environment to promote excellence

in pediatric clinical care, patient safety and education for all healthcare team members throughout the state of Alabama.

The COACHES team visits community hospitals throughout Alabama and provides an assessment of the hospital to assure they have the necessary equipment and infrastructure to care for sick children and training to hospital staff through simulation.

In 2017, the COACHES program has plans to continue this outreach education with 10 hospital visits scheduled from January through April.

Children’s of Alabama Committee for the Future

This committee gives emerging Alabama community leaders the opportunity to experience

Children’s of Alabama’s unique mission firsthand so that they may share our stories of hope in

their communities.

• Members spend an intensive in-hospital rotation day observing surgical, medical and

psychosocial services and also learn about hospital operations and research initiatives

including the role of the Pediatric Simulation Center.

• The committee is given the opportunity to observe an interprofessional simulation

scenario of a patient transferred from a community hospital by the COA Critical Care

Transport team to the Pediatric Intensive Care Unit at COA. This exercise gives the

committee an opportunity to observe the multi-disciplinary approach and training involved

in caring for critically ill children.

Trauma Prevention Program - 78 teenagers “sentenced” to children’s program after a minor

traffic infraction observed a trauma simulation during this course.

Left: COACHES team providing training at Flowers Hospital in Dothan, AL.

Page 9: Pediatric Simulation Center Annual Report 2016 Ross, RN, ECMO Paul ... • The Well Baby simulation course started in September 2016 and is done ... including the role of the Pediatric

Research - Investigating Best

PracticeOur team is actively involved in research projects to determine best practice in simulation education including teaching communication skills, clinical skills, and procedural skills. Current projects include: • Education and Training on the use of the Epi-Pen• Tracheostomy Education for Patient Families• Newborn emergency training for UAB Mother Baby Unit• Gastrointestinal Simulations for Residents• Nutrition Simulations for Residents on their Ward Rotation• Critical Actions for Nurses during the First Five Minutes of a Code • Pulmonary Simulations focusing on Smoking Cessation for Family Members• Cardiology Simulations for Residents and Nurses • Rapid Cycle Deliberate Practice training for Fellows and Residents• Rapid Cycle Deliberate Practice for the Neonatal Resuscitation Program• Global health history training for Medical Students and Interns• Neurology Simulations for Residents, Fellows and Nurses• Continuous Renal Replacement Therapy training for Nurses • Code Cart Quality Improvement • Nursing Vigilance Simulations for all Nurses in the hospital• Primary Care Clinic Simulations for Residents

Rapid Cycle Deliberate Practice, a haiku:By Nathan Swinger, MD

Reflective PracticeLearning through experienceThe RCDP

Over the past year we have used a novel form of simulation called Rapid Cycle Deliberate Practice (RCDP) to train over 70 pediatrics residents and fellows in pediatric resuscitation. Our work is on the cutting edge of resuscitation education. We have been able to demonstrate a 200% improvement in knowledge retention when compared with traditional PALS training. Moving forward we plan to expand this training to help educate other healthcare teams including nursing and respiratory therapy.

Pediatric Arrest: Simulation

starts

Trainee commits key

error or "HardStop"

Trainee is coached

Simulation resets from beginning

RCDP Training Cycle

Page 10: Pediatric Simulation Center Annual Report 2016 Ross, RN, ECMO Paul ... • The Well Baby simulation course started in September 2016 and is done ... including the role of the Pediatric

Publications / Scholarly WorkThis page and the following pages include publications and select presentations from 2016. For a

comprehensive list of our publications and presentations, please visit www.childrensal.org/PediatricSimulationCenter

Manuscripts1. Bateman LB, White ML, Tofil NM, Clair JM, Needham BL. Physician Communication in Pediatric End-of-Life Care: A Simulation Study. American J of Hospice and Palliative Medicine 2016; 33(10): 935-941.

2. Bateman LB, White ML, Tofil NM, Clair JM, Needham BL. A Qualitative Examination of Physician Gender and Parental Status in Pediatric End-of-Life Communication. Health Communication 2016; Jul 19:1-7. [Epub ahead of print] Vol 00, No 00, 1-7. PMID: 27436067.

3. Sims AN, Feig DI, Dietiker KL, Peterson DT, Zinkan JL, Youngblood AQ, Tofil NM. A novel teaching mechanism in nephrology on the dangers of hypocalcemia in chronic renal failure. Journal of Clinical Pediatric Nephrology. 2016 [Epub ahead of print].

4. Larson-Williams LM, Youngblood A, Epps N, Peterson DT, Abdullatif H, Zinkan JL, White ML, Tofil NM. A Multidisciplinary, Longitudinal Simulation to Teach Pediatric Residents and Nurses How to Diagnose, Treat, and Manage Pediatric Patients with Diabetic Ketoacidosis. World Journal of Critical Care 2016; 5(4): 212-218.

5. Cravens M, Benner K, Beall J, Worthington M, Denson B, Youngblood AQ, Zinkan JL, Tofil NM. Effectiveness of Simulation to Enhance Learning of Torsades de Pointes for Clinical Pharmacists and Pharmacy Students. The Journal of Pediatric Pharmacology and Therapeutics 2016; 21(6):476-485.

6. Nassetta L, White ML, Eschborn S, Peterson DT, Zinkan JL, Youngblood AQ, Tofil NM. Simulation to Induce and Study Premature Closure Diagnostic Error Medical Science Educator 2016;26:623-9.

7. Johnston E, King C, Cox J, Youngblood AQ, Zinkan LZ, Peterson DT, Tofil NM. Anaphylaxis in the Operating Room a Simulation Study. Pediatric Anesthesia. Accepted October 2016.

8. Cheng A, Duff J, Brown L, Bhanji F, Kessler D, Tofil N, Hunt B, Nadkarni V, Hecker K, Wan B, Lin J. for the International Network for Simulation-based Pediatric Innovation, Research and Education (INSPIRE) CPR Investigators. The effect of step stool use and provider height on quality of chest compressions during pediatric cardiac arrest: A simulation-based multicenter study. Canadian Journal of Emergency Medicine. Accepted November 2016.

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Abstracts1. Walley S, Schaefer S, Tyner T, Walker K, Powell J, Tofil NM Smoking Cessation Counseling: A Simulation Enhanced Curriculum to Improve Communication Skills in Pediatrics. Journal of Investigative Medicine. 2016.

2. Duerring SA, White ML, Tofil NM, Nafziger SM, Pruitt CM, Shah MI, Doughty CB, Baker MD. Application of Pediatric Simulation Training for emergency prehospital providers. Journal of Investigative Medicine. 2016.

3. Adler M, Overly F, Nadkarni V, Davidson J, Gottesman R, Bank I, Marohn K, Sudikoff S, Grant V, Cheng A for the International Network for Simulation-based Pediatric Innovation, Research, Education (INSPIRE) CPR Investigators. Approach to confederate training within the context of simulation-based research. Society for Simulation in Healthcare. 2016.

4.Marohn K, Sudikoff S, Brown L, Tofil NM, Peterson DT, Kessler D, Charnovich A, Hunt EA, Cheng A, Nadkarni V. Barriers to Performance of High Quality Chest Compressions Among Pediatric Providers: A Qualitative Multicenter Study. Simulation in Healthcare 2016;11(6):432.

5. Tofil NM, Brown L, Lin J, Zhong J, Peterson DT, White ML, Grant V, Grant D, Gottesman R, Sudikoff S, Adler M, Marohn K, Davidson J, Doan Q, Cheng A. Workload of team leaders and team members during a simulated sepsis scenario. Simulation in Healthcare 2016;11(6):432.

6. Bishop E, Schmit EO, Tofil N, Sasser W, Nichols M. Procedural Competence in Pediatric Residents. J of Investigative Medicine 2017; 65

Oral / Workshop Presentations1. Tyner T, Schaefer S, Powell J, Walker K, Troxler B, Tarn V, Tofil NM, Walley SC. Smoking Cessation Counseling: A Simulation Enhanced Curriculum to Improve Communication Skills in Pediatric Residents. Oral presentation at Southern Society for Pediatric Research meeting, New Orleans, LA 2016.

2. Duerring SA, White ML, Tofil NM, Nafziger SM, Pruitt CM, Shah MI, Doughty CB, Baker MD. Application of Pediatric Simulation Training for emergency prehospital providers. Accepted for an Oral Presentation for Southern Society for Pediatric Research, February 2016, First author awarded Trainee Travel Grant.

3. Winter L, Rutledge C, Zinkan JL, Tofil NM. Rapid Cycle Deliberate Practice: Bringing it Home to your Institution. 8th International Pediatric Simulation Symposium and Workshops, Glasgow, UK, May 2016.

Posters1. Brown L, Tofil NM, Overly F, Lin Y, Duff J, Bhanji F, Nadkarni V, Hunt E, Charnovich A, Kessler D, Bank I, Cheng A. Impact of a CPR feedback device on healthcare provider workload during simulated cardiac arrest. 16th Annual Meeting on Simulation in Healthcare. San Diego, CA, January 2016.

2. Brown AM, Tofil NM, Rutledge C. Improving Residents’ Knowledge of Code Cart Items and Locations Using Simulation. 8th International Pediatric Simulation Symposium and Workshops, Glasgow, UK, May 2016.

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3. Adler M, Overly F, Nadkarni V, Davidson J, Gottesman R, Bank I, Marohn K, Sudikoff S, Grant V, Cheng A for the International Network for Simulation-based Pediatric Innovation, Research, Education (INSPIRE) CPR Investigators. Approach to confederate training within the context of simulation-based research. 16th Annual Meeting on Simulation in Healthcare. San Diego, CA, January 2016. First Place - Program Innovation.

4. Winter L, Zinkan JL, Tofil NM. Rapid Cycle Deliberate Practice in Neonatal Resuscitation: A Team Based Training Approach. 8th International Pediatric Simulation Symposium and Workshops, Glasgow, UK, May 2016.

5. Winter L, Tofil NM. Enhancing Residents’ Neonatal Needle Thoracentesis Competency Through a Novel, Low Cost Model. 8th International Pediatric Simulation Symposium and Workshops, Glasgow, UK, May 2016.

6. Tofil N, Brown L, Lin Y, Zhong J, Peterson DT, White ML, Grant V, Grant D, Gottesman R, Sudikoff S, Adler M, Marohn K, Davidson J, Doan Q, Cheng A. Workload of Team Leaders and Team Members During a Simulated Sepsis Scenario. 8th International Pediatric Simulation Symposium and Workshops, Glasgow, UK, May 2016.

7. Rutledge C, Youngblood A, Zinkan L, Tofil NM. Improving Care of the Deteriorating Patient Through Interprofessional Simulation. 8th International Pediatric Simulation Symposium and Workshops, Glasgow, UK, May 2016.

8. Johnston E, King C, Cox J, Youngblood AQ, Zinkan JL, Tofil NM. Pediatric Anaphylaxis in the Operating Room for Anesthesia Residents: A Simulation Study. 8th International Pediatric Simulation Symposium and Workshops, Glasgow, UK, May 2016.

9. Zinkan JL, Youngblood AQ, Wise K, Whitfield A, Hicks J, Tofil NM, Rutledge C. Nursing Vigilance: Simulation to Decrease Codes Outside the ICU. 8th International Pediatric Simulation Symposium and Workshops, Glasgow, UK, May 2016.

10. Swinger N, Rutledge C. Gaither S, Whitfield A, Youngblood A, Zinkan JL, Tofil N. Variable Interval Training for Active Learning. UAB Research in Medical Education. September 2016.

11. Sloane P, Hillman K, Zinkan JL, Youngblood A, Tofil N. Caregiver Reception of High-fidelity Simulation: Enhanced Tracheostomy Discharge Education. University of Florida Medical Student Research Forum. Lake Buena Vista, FL, September 2016.