SimulationAnnualReport

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I n p a r t n e r s h i p w i t h :I n t e r i o r H e a l t h  

U B C F a c u l t y o f M e d i c i n e  U B C O S c h o o l o f N u r s i n g

Executive Summary

Interior Health (IH), the University of British Columbia (UBC) Faculty of Medicine (FoM), and University of British Columbia OkanaganSchool of Nursing (UBCO SoN) have formed a partnership to work collaboratively in order to provide simulation education activities forundergraduate, postgraduate, practicing clinicians and physicians across UBC and Interior Health (IH).

Fiscal Year 2018-19 saw a tremendous growth across all simulation programs centres/programs where the utilization (hours) ofsimulation education increased 17% from 2017-18.  We anticipate that these numbers will continue to grow as more requests forsimulation type education for under grad, post grad, practicing clinicians and external agencies continue.

One of the main focuses for this year was to formalize facilitation and the debriefing structure and resources.  Collaboration provinciallycreated modules on facilitation and in situ readiness resources. In situ, or in the department, sessions have increased exponentially atthe fixed simulation centres.  Although we have been running interprofessional in situ sessions at rural hospital sites since 2009, thelarger hospital sites are seeing the benefits.  Through interprofessional simulation education, departments are able to review and makechanges to processes, equipment, teamwork and communication and identify latent events, or potential safety threats.  Many qualityinitiatives have been identified through in situ sessions which ultimately will improve patient safety.

Vision & Mission Statement

VisionTo support excellence in healthcare delivery through the use of simulation basededucation.

MissionTo facilitate simulation-based education that:

promotes inter-professional engagement and collaboration; andsupports highly competent providers to achieve excellence in health caredelivery

YearlyHighlights

Every year the IH Rural MobileSimulation Program facilitatorscome together for their AnnualSimmit.  In the 2018-19 year, weinvited Dr. Melissa Chan and Dr.Jasmine Allaire to assist infacilitation and debriefing. Dr.Chan is the representative for BCChildren's Hospital in Vancouver,for trekk.ca "TranslatingEmergency Knowledge for Kids". She and Dr. Allaire shared theirknowledge and resources forPediatric  Emergency Medicine.

There are various provincialprograms that UBC ContinuingProfessional Development(CPD)  supports.  In 2018, theIH Simulation Programcollaborated with the:

Mobile Medical Unit (MMU)Enhanced Simulation ofCritical Care andPerioperative Emergencies(ESCAPE)Simulated Trauma UpdateCourse (STRUC).

Simulation Facilitation Pathways - e-learningModules. An initiative led by Vancouver Coastal,brought simulation facilitators across British Columbiato develop nine e-learning modules on facilitation: Introduction; Learning theories; Attitudes; Pre-course;Pre-scenario; What is Debriefing; Debriefing: BlendedModels; Focus on Analysis and Pitfalls. Chelsea Holmesand JoAnne Slinn took part in developing Pitfalls.Pre and Post Simulation Checklist - HelenClugston co-created a safety checklist to minimize theimpact on staffing.  The checklist looks at the staffingneeds, acuity, workflow, equipment, safety, infectioncontrol, confidentiality and recording.

StandardizationAcross the Province

ProvincialSIMS Collaboration

Annual Simmit

KnowledgeDissemination

01 Emergency Nursing Association of BC Conference (ENABC)

The ENABC executive invited simulation educators Chelsea Holmes, Jaime Gallagher, and JoAnneSlinn to present at their annual conference that was held at the British Columbia Institute ofTechnology (BCIT) in Vancouver.  As plenary speakers, the educators presented on Simulation forQuality Improvement in the ED.  In the afternoon, our educators joined with others to run pediatricand adult simulation sessions. 

02 2018 National Forum on Simulation for Quality & Safety

JoAnne Slinn travelled to Toronto for the national conference to represent Kelowna GeneralHospital's ED in situ project, which is a shared initiative with the University of British Columbia(UBC) and Interior Health (IH). In 2015, an ED in situ simulation program at Kelowna GeneralHospital was instituted with multiple aims. Through this program they were able to identify latentsafety threats, test new patient care protocols, find equipment issues, and foster teamwork in asustainable way to improve the quality of care in our ED. This presentation allowed them to sharethe valuable work we are doing in Interior Health (IH), and gain recognition for UBC and IH inleading patient safety initiatives through simulation.

03 Gateway Debriefing Skills Workshop: An Introduction to Debriefingwith Good Judgement

As part of Western Canada Health Sciences Educators Conference all IH Regional KnowledgeCoordinators and our Medical Director were able to attend this workshop put on by the Center forMedical Simulation that is affiliated with Harvard University. This course provided the opportunityfor participants to learn how to efficiently improve future performance, learn how to set highstandards while holding high regard for the learner, treat learners as thinkers and not just doers,and practice various debriefing phases.

N a t i o n a l F o r u m o nS i m u l a t i o n Q u a l i t y &

S a f e t y

04 National Emergency Nurses Association (NENA) ConferenceChelsea Holmes, Jaime Gallagher, and JoAnne Slinn presented on Rural Simulation. Theyhighlighted the benefits of in situ simulation and interprofessional participation, latent safetythreats, facilitation, challenges and lessons learned. Pre-conference concurrent sessions wereheld in the Pritchard Simulation Centre, where participants could choose between Pediatric Skillspractice or the Emergency Practice, Interventions and Care (EPICC) course.

05 Canadian Association of Emergency Physicians (CAEP) ConferenceJoAnne Slinn attended the CAEP Conference and presented on “Simulation for EmergencyDepartment Quality Improvement at Kelowna General Hospital”. She discussed the qualityimprovement initiative used in situ simulation as a QI tool, how they were able to identify latentsafety threats, test new patient care protocols, find equipment issues, and foster teamwork in asustainable way to improve the quality of care in our ED.

06 IH Rural Health Services Research Conference

N a t i o n a l E m e r g e n c yN u r s e s A s s o c i a t i o n( N E N A ) C o n f e r e n c e

KnowledgeDissemination

JoAnne Slinn and Dr. Tara Gill did a poster presentation on our research "Does Simulation Enhancethe Knowledge and Appreciation of Interior Health Pre-printed Orders (PPOs)?"  They were able toshare results that showed substantial improvements in comfort levels in suing the Severe AdultEmergency Department Pre-printed Order (PPO), and improved confidence in the assessment andmanagement of a severe adult asthma patient.

Advanced Cardiac LifeSupport (ACLS) Advanced Trauma LifeSupport (ATLS)Acute Care of the At RiskNewborn (ACORN)Basic Life Support (BLS)Emergency Practice,Interventions and CareCanada (EPICC)Essentials of CriticalCare Orientation (ECCO)In situ - simulation onvarious unitsInternational TraumaLife Support (ITLS)

Mock codesMOREob Action toConsolidate (ACE) DaysNeonatal ResuscitationProgram (NRP)Nursing clinicalcompetency simulationsessionsNursing specialtytrainingOutreach simulationtraining

Pediatric Advanced LifeSupport (PALS)Physician specialtytrainingPreventing Alcohol andRisk-related Trauma inYouth (PARTY) Respiratory Therapysimulation sessionsTrauma Nursing CoreCourse (TNCC)

Interior HealthEducation

Session Total Time

FY 2017 FY 2018

0

1000

2000

IH Interior Health

Hou

rs

1665

1749

Emergency Department (ED in situ)

Mock Code STEMI

Pop up ICU SIMS

Wards where simulation education occurred:Ambulatory CareCath LabDiagnostic ImagingEmergencyIntensive CareNeonatal Intensive Care Unit (NICU)Operating RoomPediatricsPost Op Recovery Room (PARR)Primary CareSafe Consumption SiteUrgent Care

Mock Code Pink

in situEducation Operating Room in situ

Requests for in situ (in the department) simulation has seenthe largest growth this year.  Quality Initiatives have broughtforward changes in processes, equipment, pre-printedorders, and communication to name a few.  Latent events, or"near misses" are frequently identified through simulationeducation.  

Maternity SimulationStudent Nurse Year 3

UBCO School of NursingEducation

Nursing Practice with Childbearing Families(Maternity)This specialty practicum develops beginningknowledge, skills, and abilities to provideevidence-informed nursing care in newbornfamily health contexts. Students engage inintentional learning opportunities in a varietyof contexts: simulation, laboratory, acute andmaternity care settings, self-directed onlinemodules, and interprofessional health careteams.

Pediatric SimulationStudent Nurse Year 3

Child Health Practice (Pediatrics)This specialty practicum developsbeginning knowledge, skills, andabilities to provide evidence-informed nursing care in a variety ofchild health care contexts. Thenursing practice experiences takeplace in the simulation lab, schoolsand in the acute care setting.

Session Total Time

UBCO School of Nursing (Uni..

0

10

20

30

40

50

60

70

80

FY 2017 FY 2018

Hou

rs

51

79

NB:  In 2017, the Maternity sessions were not held, which reflect the greater number of hours in 2018.  

Undergraduate Year 1-4

Y 2 - Transition into ClinicalPractice (TICE), UltrasoundY 3 - Curriculum basedSIMS:  Anesthesia (including Peerled & Academic Half Days),Cardiology, Emergency;InternalMedicine, Neurosurgical,Orthopedics, Pediatrics,Surgical, and Trauma, extracurricularY 4 -Transition intoProfessional Practice (TIPP)

Monthly ED in situMonthly in centresimulationAirway DayPoint of CareUltrasound (POCUS)

PostgraduateEmergency Medicine (EM)

Year 1-5

PostgraduateFamily Practice (FP)

Year 1 & 2

Resident BootcampsPeer-led sessionsMD Supported SIMSAcademic Half DaysAdvanced CardiacLife Support (ACLS)Pediatric AdvancedLife Support (PALS)Maternity SIMSNeonatalResuscitationProgram (NRP)ED in situUltrasoundOpen invitation tojoin other SIMS

UBC Faculty of MedicineEducation

364

539

Session Total Time

FY 2017 FY 2018

0

100

200

300

400

500

600

UBC FoM

Hou

rs

364

539

Awards

1 .   C h e l s e a H o l m e sU B C I n t e r i o r Fa m i l yP r a c t i c e R e s i d e n c y S i t eTe a c h i n g A w a r d .

2 .   J o A n n e S l i n nU B C I n t e r i o r E m e rg e n c yM e d i c i n e N u r s e R e s i d e n tE d u c a t i o n A w a r d

These awards recognizepreceptors/teachers whohave demonstratedexcellence in teachingfrom the perspective ofthe residents.

C h e l s e a H o l m e s J o A n n e S l i n n

UBC Faculty of MedicineAwards

282Interior Health

1749 257

Fixed Simulation Centres

PritchardSimulation Centre

Since 2016, the PSC has seen aconsistent 25% growth inutilization each year.

Rae FawcettSimulation CentreHours increased by 190%between 2016-17 (centreconstruction year) and 2017-18(fully operational).The centre sawa 7% growth in utilization this pastyear.

Kootenay BoundarySimulation Program

UBC FoM(under grad) UBC FoM (post grads) UBCO School of Nursing

79

Simulation Hours (2018-19)

Metrics

A Regional Knowledge Coordinator (.4FTE) was hired in September 2017. Theprogram saw a 25% growth in utilizationbetween 2017-18 and 2018-19.

Utilization Yearly Comparison

Pritchard Simulation Centre Rae Fawcett Simulation Centre Kootenay Boundary Simulatio.. Total Utilization

2014-15 2015-16 2016-17 2017-18 2018-190

500

1000

1500

2000

2500

Hou

rsOverall Growth

The Simulation Programs combined saw a17% growth in utilization between 2017-2018 and 2018-19.  

Fixed Simulation Centres2018-19

Consolidated knowledge and identifiedknowledge gapsVery applicable to current patient in ICUGreat to have exposure to paediatriccases and to learn practical skills in acutemanagement scenarios

Evaluation

Strong Features

   Participant feedback

Feedback for change

Switching roles and tasksMore skills training would be helpfulNone, appreciate the flexibility to makeSIMS what we needReview important SIM principlesbefore first case; assign roles, closedloop communication, invite everyoneto review things they are not confidentin.

57Thompson/Cariboo

119 35

IH Rural Mobile Simulation Program

Rural Sites Visited

Travel occurs in the spring and fallonly.

Twenty One

Facilitators

We have nurse/physicianfacilitators teams that live andtravel in the four geographicalarea.

Nineteen

Number of Rural andRegional HospitalSites in IH

Twenty Nine

Kootenay Boundary Okanagan East Kootenay

30

Sites visited

2018-19

Simulation Attendance (2018-19)

Metrics

IH Rural Mobile Simulation Centre

I'm motivated to try and encourage RNs to takemore leadership roles when I need to do aprocedure.  Will try and do a better job ofempowering them to feel they can do it.Know the department betterHaving more confidence in approaching criticalcases.The debriefing afterwards was super helpful andsupportive.  Did not feel like anyone was beingsingled out.  The feedback was provided in apositive way (which promoted positive change).

Participants were asked what wouldthey change in their practice

    Participant feedback

Participants were asked what wouldthey like to see done differently

More simulations, more opportunities to changerolesI actually find these sessions keep getting betterso I wouldn't do anything differently

2018-19

Thank you for including me in the simulator in Sparwood. It was great to be part of twoscenarios, with different physician and nurse leads for each. I feel like we learned how tobetter use closed loop communication, challenging the leader during a crisis (not in aconfrontational way, but as a way to offer constructive input), and the capabilities of thehospital for trauma management.

I look forward to implementing the communication pieces into my practice as a paramedic.

Kind Regards,Daniel BybeeBCEHS, Kimberley

YOU'VE GOT

MAIL

Evaluation

DonorHighlights

In 2016, six  IH Foundations contributed toa SimMan3G that is housed at the KootenayBoundary Regional Hospital and sharedacross sites.  

Interior Health Foundations

Raw Fawcett has embracededucation and supported the RaeFawcett Simulation Centre bypurchasing equipment since 2015.

2015 - SimMan3G, SimJunior,Victoria Birthing Simulator,SonoSite EDGE Ultrasound2018 - SuperTory (neonate) *

Rae Fawcett

The Colin and Lois PritchardFoundation has made manycontributions to the PritchardSimulation Centre in Kelowna sincethe build in 2011.  

2011 - Infrastructure, SimMan3G,Harvey Simulator2015 - SonoSite EDGE UltrasoundSystem (2)2018 - Supertory (neonate) *

Colin and LoisPritchard

*Supertory is a neonate simulator that provides learners with experience in dealing with rare pediatric emergencies safely.

Sindi Ahluwahlia Hawkins Centre forthe Southern Interior

In 2019, the BC Cancer agency donated aGlidescope & Anesthesia Machine to be used foreducation at the Pritchard Simulation Centre.

J o A n n e S l i n n h a s b e e np r o m o t i n g s i m u l a t i o nb y d o n n i n g h e r t - s h i r t

“ # S I M L I F E ” i n l o c a ls i m u l a t i o n s e s s i o n s

a n d t h r o u g h t h eB r i t i s h C o l u m b i a

S i m u l a t i o n N e t w o r k( B C S N ) . T w i t t e r i s l i t

u p ! @ s l i n n j o a n n e

Loving this#SIMLIFE

Promotion

Simulation Team at  Interior HealthTop Left to right:  JoAnne Slinn, Helen Clugston, Chelsea Holmes

The Team