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Welcome. ‘Teaching Patient Safety’ Laerdal SUN 2009 San Francisco, California October 21, 2009. Brief Introduction. Laura Mosesso Project Manager, SimMedical Aimee Smith Production Manager, Curriculum Development WISER/SimMedical. Agenda. Tell us about you! Audience Response System

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‘Teaching Patient Safety’

Laerdal SUN 2009

San Francisco, California

October 21, 2009

brief introduction
Brief Introduction
  • Laura Mosesso
    • Project Manager, SimMedical
  • Aimee Smith
    • Production Manager, Curriculum DevelopmentWISER/SimMedical
  • Tell us about you!
    • Audience Response System
  • What are Response Teams and Initial Responders?
  • Simulation Session
  • Debriefing Exercise
  • Curriculum Exercise
  • Courseware Review
  • Question and Answer Session
what is your primary role at your facility
What is your primary role at your facility?
  • Clinician
  • Clinical Educator
  • Educator (Not clinically active)
  • Administrator
  • Simulation Operator
  • Other
if you are a clinician tell us more
If you are a clinician, tell us more!
  • RN
  • MD
  • Respiratory Therapist
  • Paramedic / EMT
  • Other
why are you here are you interested in
Why are you here? Are you interested in…
  • Rapid response team training
  • Initial in-hospital responder training (prior to code team arrival)
  • Learning what others are doing
  • Looking for ways to improve what you are already doing
what are you currently doing for team or initial responder training
What are you currently doing for Team or Initial Responder training?
  • Course material only
  • Course material and simulation sessions
  • Simulation sessions only
  • Not teaching
why simulation based training
Why Simulation-Based Training?

In the United States:

  • Average 1.2 million healthcare related incidents per year
  • $29 billion a year associated with medical errors
  • 66% of medical errors are associated with communication issues
why simulation based training9
Why Simulation-Based Training?

According to the 1999 Institute of Medicine Report ‘To Err Is Human’, approximately 100,000 Americans die each year from ‘preventable’ hospital errors. The annual toll exceeds the combined number of deaths and injuries from motor vehicle and airline crashes, suicides, falls, poisonings and drownings.

why simulation based training10
Why Simulation-Based Training?

To Err Is Human; Building a Safer Health System

“The Committee believes that health care organizations should establish team training programs for personnel in critical care areas (e.g., the emergency department, intensive care unit, operating room) using proven methods such as the crew resource management techniques employed in aviation, including simulation.”

what is a rapid response team
WHAT is a Rapid Response Team?
  • Also known as Crisis Team (CT), Medical Emergency Response Team (MET) or Code Team
    • Teams of clinicians rush to a patient’s location whenever a clinician feels the patient’s condition is deteriorating or has deteriorated
    • Teams are designed to rescue patients early in their decline, before an adverse outcome occurs
  • Hospitals using Rapid Response Teams report reductions in the number of cardiac arrests, unplanned transfers to the ICU and in some cases, overall mortality rates
why rapid response team training
WHY Rapid Response Team Training?
  • The Joint Commission
    • 2008 National Patient Safety Goals
      • Goal 16: Improve recognition and response to changes in a patient’s condition.
        • 16A: The organization selects a suitable method that enables health care staff members to directly request additional assistance from a specially trained individual(s) when the patient’s condition appears to be worsening
why rapid response team training13
WHY Rapid Response Team Training?
  • IHI: Institute for Healthcare Improvement

100,000 Lives Campaign

    • Introduces proven best practices to extend or save as many as 100,000 lives by reducing morbidity and mortality
    • Activating a Rapid Response Team is one of six strategies to prevent avoidable deaths
        • Deploy Rapid Response Teams…at the first sign of patient decline
what is an initial responder
WHAT is an Initial Responder?
  • Wikipedia
    • Initial or First Responderis a term used to describe the first medically-trained responder to arrive on scene of an emergency
    • The first stage of being a first responder is being able to recognize what it is that you are required to know and perform the necessary interventions
why initial responder training
WHY Initial Responder Training?


High percentage outside critical care areas

Survival highly dependent on Initial Responders

Multiple factors influencing patient outcomes include:

Patient co-morbidities and initial cardiac rhythm

Duration of incident and time to defibrillation

Need for rapid and effective BLS and ACLS

why initial responder training16
Importance of sufficiently trained personnel

Perform effective BLS

Initiate early intervention and defibrillation if needed

AED utilization

Less intimidating

Support rapid defibrillation

WHY Initial Responder Training?

WHY Initial Responder Training?

  • On average, greater than 9 minutes to shock patient
  • Less than 10% of patients are provided proper BVM ventilation
  • 40% of nurses did not know the correct phone number to activate the Rapid Response Team
  • Patient report was inconsistent
  • 80% of nurses did not set the defibrillator to the appropriate mode
how do you run scenarios
How do you run scenarios?
  • On the fly
  • Programmed but always tweaking
  • Preprogrammed

*may select more than one answer

how do you debrief
How do you debrief?
  • Record video
  • Use checklists
  • Collect data
  • Utilize Laerdal software and hardware
  • Other

*may select more than one answer

simulation scenario
Simulation Scenario
  • 3 volunteers needed
  • 3-5 minute scenario
  • Observers - please take notes to debrief as you would normally at your organization
  • Volunteers - scenario orientation to:
    • Setting
    • Equipment
    • Roles
patient report
Patient Report

Location: Non-Monitored Bed Unit

Patient: William Roberts

Patient Information: 82 year old male post-operative for hernia repair

Past Medical History: Myocardial Infarction

(4 years ago)

Meds: Aspirin daily

debriefing exercise
Debriefing Exercise

Please share 1 -2 of your debriefing points.

problem with current debriefing methods pick your greatest pain
Problem with current debriefing methods (pick your greatest pain)
  • Too many instructors debriefing differently
  • Ineffective assessment tools
  • Lack of standard debriefing points
  • Inconsistent scenario progression
  • Think back to the scenario…let’s discuss the following:
    • Would tools have helped with the assessment?
    • Do you feel tools would help relate the debriefing to scenario objectives?
    • Would tools provide standardization to the instructor community?
    • Is it important to assess the same way with each training / scenario session?
scoring tools exercise
Scoring Tools Exercise
  • Think back to the scenario…
    • Use the Assessment Tool to document volunteer actions during the scenario
  • Let’s discuss the following…
    • Standardized debriefing points
scoring tools
Scoring Tools
  • Standard assessment and debriefing tools help to
    • Keep instructors focused
    • Clearly outline learning objectives
    • Structure debriefing sessions
    • Gather valid research data

These are all common problems in simulation-based training today!


What is a Course?

Before Class

During Class

After Class


Based on the above information, please share your thoughts on what would go into each category.


What is a course?

Before Class

During Class

After Class

Participant content



Instructor content




  • SimMedical, in partnership with Laerdal Medical, is pioneering simulation-based education materials
  • Joint venture offers curricula / courseware that is:
    • Developed by board-certified clinicians and other content experts
    • Designed with simulation educational methodology that incorporates healthcare best practices
    • Created with a variety of learning techniques to maximize retention of material
the first 5 minutes
The First 5 Minutes®

All the materials needed to deliver a robust simulation course

  • Course Goals:
    • Early recognition of critically ill hospital patients before the code team arrives promoting improved outcomes
    • Establish standardized behaviors for the initial hospital responders
  • Target Audience:
    • Healthcare staff that are the initial responders to a patient in crisis such as non-critical care nursing staff, nursing students, respiratory therapists, physical/occupational therapists, et al.
the first 5 minutes31
The First 5 Minutes®
  • Why?
    • Floor nurses and other hospital staff are undertrained or are not trained to deal with patients in crisis
    • Teaches staff how to manage patients in crisis prior to the actual code team’s arrival
    • Part of a hospital quality patient safety program
    • Meets regulatory requirements
rapid response team training
Rapid Response Team Training

Simulation-based educational training program

  • Course Goals:
    • Develop critical team building skills
    • Improve communication
    • Promotes efficient teamwork
  • Target Audience:
    • Clinicians who are part of the actual code team that take over from the initial hospital responders
    • Roles include physician, nurse, pharmacist, and respiratory therapist
rapid response team training33
Rapid Response Team Training
  • Why?
    • Promotes the fundamentals of teamwork
    • Emphasis on communication
    • Strong focus on the importance of practice
    • Meets regulatory requirements
    • Developed by Michael DeVita, MD
      • International leader in rapid response systems and simulation training
      • Current President, Society for Simulation in Healthcare