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

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

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

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  1. Improving Care for PediatricsNancy M. Tofil, M.D., M.Ed.October 2011

  2. Disclosure • I have no conflict of interests to disclose

  3. Overview 0-5min Introduction/Turning Point Slides 5-15min Objectives 15-45minReview Pediatric courses and opportunities 45-60min TAPPS – List barriers and discuss strategies to overcome to overcome the barriers 60-75min Wrap-up / Top 10

  4. How long have you been involved in simulation? 0-6months 6-12months 12-18 months 18-24 months 2-5 years > 5years

  5. What is your role? Simulation technologist Nurse educator Physician/ Advanced provider Administrator Other

  6. Who is your primary learner? • Nurse • Medical Student • Resident • Staff Physician • EMT • Other

  7. Where is your center located? • Free standing • In hospital • In nursing or allied health school • In medical school • Other

  8. Which high-fidelity pediatric simulators do you have? Laerdal SimBaby Laerdal SimNewB METI Child Gaumard More than one type None yet

  9. What do you feel is the biggest obstacle you face concerning moving simulation forward at your institution? Financial related Technical knowledge Time constraints Hospital support

  10. What is your primary goal from this workshop? • Programming Advice • Ideas for pediatric sim courses • Strategies to move your center ahead • Product advice • Obtain new scenarios • Other

  11. Learning Objectives • Discuss the medical/legal environment in the pediatrics area • Identify issues specific to pediatric care • Describe the history of pediatric simulation • Describe the role of simulation in providing quality pediatric education • Discuss collaboration with multidisciplinary leadership • Describe how to plan and implement pediatric simulation • Define measurable objectives for success

  12. Medical/Legal Environment • Patient safety • Resident duty hours • Transition of responsibility to fellows and attendings • Nursing students less exposure • New nurses less skilled

  13. 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

  14. 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

  15. Role of Simulation in Providing Quality Pediatric Education Clinical Education Inefficient No Debriefing No scheduled admissions

  16. 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

  17. Kolb’s Experiential Learning Cycle* Concrete Experience Simulation Practicing Standardize exposure Scheduled debriefing Active experimentation Reflective Observation Debriefing Abstract conceptualization Relating to actual situations, developing rules, algorithms *Kurt Lewen

  18. Children’s of Alabama Pediatric Simulation Center • Began August 2007 • 8 Mannequins • 3 Simulation rooms • Conference room • Audiovisual capability in all rooms • Storage

  19. 15,000 learners

  20. Our Mannequins • SimBaby x2 • SimNewB • SimMan • SimMan Essential • METI PediaSim • Gaumard Pediatric Hal 1 Year • Gaumard Pediatric Hal 5 Year

  21. Multidisciplinary Courses • Radiology (Attending and Technologist) • ECMO (ECMO Team) • PICU (Physician, Nurse and Pharmacy) • Mock Code (Code Team) • Trauma (Trauma Team) • Death and Dying (Physician, Nurse, Social Work and Chaplain) • Forensic Evidence (Physician, Nurse) • Medical Student Clerkship (Medical, Nursing and Pharmacy Students) • Sedation (Physician, Nurse, Technologist) • Cardiovascular (Physician, Nurse Practitioner, Nurse)

  22. ECMO

  23. PICU

  24. Mock Code

  25. Trauma

  26. Death and Dying

  27. Forensics – Sexual Abuse Evidence Collection

  28. “Silo” Courses • Orthopedics • Anesthesia and CRNA • Pharmacy Student • PICU Nursing • Solid Organ Transplant Nursing • Dialysis Nursing • NICU Nursing

  29. Orthopedics

  30. Anesthesia and CRNA

  31. NICU Nursing

  32. Specialty Courses • Nursing Skills Labs (First 5 Minutes of a Code) • PALS • Geriatrics • NRP • Clinical Assistant • New Hire Nursing Assessment • Sleep Technologists • Nursing Mock Code Orientation • Home Ventilator • Teen Trauma Prevention • Medication Errors

  33. Geriatrics

  34. Home Ventilator Simulation for Parents

  35. Workshops • Tracheostomy • Intubation • Basic Airway • Surgical Airway • Crisis Resource Management • Intern Skills • ENT Foreign Body Removal

  36. Basic & Advanced Airway

  37. ENT Foreign Body Retrieval

  38. Intern Skills

  39. Where to begin • 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 IDEAS FOR CASES Sentinel events Near misses Rare events (contrast reactions) Safety & equipment issues Requests Codes Premature Closure Hand offs

  40. Process • 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 RESOURCES Online: forms, scenarios, programming, moulage Internal: staff Networking Organizations List serves

  41. Make It Interesting • Moulage • Family members • Xrays, labs, ECG • Clothes, wigs, toys, eyeglasses • Voices • Use real equipment (no pretending) • Unusual distracters (impaired clinician, family issues)

  42. Moulage

  43. Accessorize

  44. Evaluation: Generic I am a MD RN Resp Therapy Pharmacist Radiology Tech Nursing Student Medical Student Chaplain Social Work Other_______

  45. Evaluation • Do you feel your participation in this course will improve your performance as you encounter medical complications in the actual clinic setting? • Two things I liked/learned today: a) b) • Two things I wish we had focused on or that could be improved: a) b) Comment/Suggestions/Recommendations:

  46. TAPPS • TAPPS – Think Aloud Paired Problem Solving1 • 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

  47. 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

  48. Top 10 9. Caregiver (parent, spouse, child) Hospital volunteer Medical student

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