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

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

17. 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

18. 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

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

20. 15,000 learners

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

23. 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)

24. ECMO

25. PICU

26. Mock Code

27. Trauma

28. Death and Dying

29. Forensics – Sexual Abuse Evidence Collection

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

31. Orthopedics

32. Anesthesia and CRNA

33. NICU Nursing

34. 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

35. Geriatrics

36. Home Ventilator Simulation for Parents

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

38. Basic & Advanced Airway

39. ENT Foreign Body Retrieval

40. Intern Skills

41. 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

42. 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

43. 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)

44. Moulage

45. Accessorize

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

47. 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:

48. 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

49. 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

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