Southwestern Virginia’s Regional Clinical Simulation Centers

1. Southwestern Virginia’s Regional Clinical Simulation Centers If I only knew then what I know now… Presented by: Cynthia G. Cunningham, MSN, RN

2. June 8, 2005 State Council of Higher Education in Virginia (SCHEV) and regional nursing programs met to explore ways of partnering with public and private entities to: Maximize the use of scarce resources Address the shortage of nursing faculty Explore alternatives for nursing student clinical education

3. THE PARTNERSHIP Collaboration of nursing educators to develop strategies to address the shortage Radford University Jefferson College of Health Sciences Wytheville Community College New River Community College Virginia Western Community College Patrick Henry Community College

4. RU SON ASSUMED LEADERSHIP Developed the CSC concept Submitting CSC proposal to SCHEV Proposal was included in the Governor’s Budget for the next biennium Funding for the project was allocated to Radford University in July 2006

5. OVERALL GOAL OF THE CSC To alleviate the shortage of nurses in Virginia by increasing the capacity of nursing schools to enroll students, maximizing use of faculty resources, and decreasing competition for scarce clinical sites

6. VISION The Clinical Simulation Center’s will provide a hands-on learning experience in an environment that is safe and realistic, producing quality nurses with enhanced critical thinking abilities, communication skills and collaboration experience

7. THE BUSINESS PLAN • History • Profile • Business Summary • Product/Services • Industry Analysis • Marketing Analysis • Organization/Management • Financial Section • Assumptions • Revenue Streams • CSC Budgetary Projections • Personnel • Operating • Equipment Lists

8. SIMmares The renovation Definition: Simulation based “disturbing” dreams. Typically occurring between 3am - 5am. Occasionally may happen during the day.

9. Renovation/Space Planning Team CSC Director Facilities Planning and Construction Laerdal Sales Rep Education Management Solutions (EMS) Hardware Design Specialist Create-a-lab Rep

10. SIMmare #1 My renovation team is gone and I don’t know what I am doing….

11. Renovation team turn over…... Laerdal rep decided to change territories Wanted to move back to Texas ………… Education Management Solutions (EMS) rep decided traveling was not conducive to a personnel life! Was married within a year Create-a-lab rep decided to start a family Had a bouncing baby boy Do you think it could be me?!!!!

12. If I knew then what I know now I would have an exit review with any renovation team member leaving the project. I would visit more SimCenters and ask more questions r/t design I would participate in more SUN’s

13. And if necessary ………….

14. I live on the Lake and have a boat and SeaDoo… Great for entertaining …..boating…..fishing……relaxing...

15. I have two Newfoundlands ……..and they are great with children

16. Due renovation team turn-over I ASSuME’d and my new team members ASSuME’d

17. SIMmare #2 The control room CONNECTIVITY

18. If I knew then what I know now I would have clear operational expectations – central control room separate from SIMroom with A/V observation I would include IT in the renovation team I would include – SimPhones to connect each SimRoom to each control room operating station

19. My SIMteam RU SON CSC Director (MSN) RHEC Site RU West Site 2 MSN’s, 1 IT Specialist 1 Admin Specialist II 2 MSN’s, 1 IT Specialist 1 Admin Specialist II VWCC PHCC JCHS RU WCC NRCC RU

20. SIMmare #4 Receiving and Installing 1.9 Million Dollars of Equipment Of course spending was not the nightmare…. Receiving, installing and tagging all items > $5000 and all IT equipment was!

21. Receiving Equipment - Laerdal This doesn't look good Include “on-site delivery & installation” in purchasing agreement Humm

22. Sturgis DREAMS: Russell returns to Virginia Purchasing Agreement Laerdal representative after receiving equipment – manikins, room furnishings, task trainers, virtual IV……

23. Installing Equipment Room set-ups per site: • 1 Med/Surg SimRoom • 1 ICU SimRoom • 1OB SimRoom • 1 Pediatric SimRoom • 2 Exam Rooms • 1 Multipurpose classroom with 3-5 patient beds • Simulation Apartment • Computer Classroom Manikin Assembly: • 4 SimMan • 4 SimBaby • 2 Nursing & 2 ALS Anne’s • 2 MegaCode & 2 Nursing Kelly’s • 2 Nursing & 2 MegaCode Kid’s • 2 Nursing Baby • 2 Noelle • 4 Adult & 2 Peds Virtual IV, • …….

24. Installing Equipment - Laerdal Ouch! SimMan kicked me! SimMan, try to behave yourself

25. Sturgis DREAMING: My new territory …TEXAS! Laerdal representative after installation of equipment

26. Installing A/V & IT equipment Room set-up x 7 per site: • 2 Pan Tilt Zoom Cameras • Microphone • Cabling between room and control room to connect (cat 5, extender boxes) • Cabling between room and server room (A/V connections) • Cabling between control room and server room Server Room: • 2 DVR’s • 2 computers to control DVR • 1 computer to manage video • 1 SQL server (database) • 1 IIS server (web) • 1 Quantum Tape Library • 1 SNAP Server for video storage

27. Installing A/V & IT equipment

28. If I knew then what I know now I would hire 1 IT specialist and 5 MSNs: Rationale for one IT specialist: A bored IT leads to a gone IT Most everything can be fixed remotely Standardization between sites Rationale for Additional MSN: Increased capacity of student’s served (450 students/semester) Increased volume of scenarios produced Back-up for staffing due to illness/surgery, time off….

29. SIMmare #5 Manikin responses are not in sync with monitor readings or scenario program Another CONNECTIVITY Problem

30. Nine Pin Problem PROBLEM: • Cable extender box – nine pin connection – transmission delays between control room and manikin. Manikin pulses and heart rate did not correlate with programmed settings and monitor waveforms (EKG, Pulse…) SOLUTION: • Pull nine-pin cable through wall/ceiling and directly connect to laptop, i.e., by passing the rose boxes.

31. If I knew then what I know now I would request that integrating equipment be tested with the manikin system prior to purchase or include a contingency plan for beta testing in the purchasing agreement

32. Imagine: No Monitors Imagine: No plan to connect manikin to the Laptop CONTROL ROOM

33. MED/SURG ROOM

34. OB ROOM

35. PEDIATRIC ROOM

36. INTENSIVE CARE ROOM

37. DEBRIEFING ROOM

38. Lessons Learned Over TIME Scenario Development Revenue Planning • Student driven • Organization • Admission ticket • Incorporate pre/post encounter evaluation and add NCLEX ? to pre • Reinforce concepts/nursing process included in “admission ticket”, pre-encounter, and scenario • Incorporate NCLEX ?s • Start early… • Partner and/or barter with as many organizations as possible • Charge fee for unused time • Block scheduling Student Preparation & Evaluation Partnering/Bartering Organized Debriefing Scheduling

39. Curriculum Integration • Orientation • Boot-camps • Fundamental • Front-loading • Standardized patient encounters • Mental health • Assessment, H&P • Follow course syllabus when choosing scenario

40. Consider fidelity • Choose the “right” manikin/SP for the simulation • If equipment is needed actually use the equipment – headwall O2/suctioning, IV pump, 12-lead…. • Include supporting documentation – SIMChart • Suspend disbelief – do not ask students to “pretend” or use phrases like “if you were taking care of a real patient….you would…..

41. Student Driven NOT Operator Driven • Student intervention or non-intervention dictates manikin action • All vocals are pre-recorded • Use handlers for all actions that are not tied to time or sequencing • If sequencing is important, incorporate standardized cues (vocal, manikin action)

42. Scenario Development Process Lessons Learned SCENARIO DEVELOPMENT & REVIEW & STORAGE • Standardized event menus • Indicate events with v. if vocal is attached • Lab reports, xrays,…as pdf files to display on pt. monitor • Scenarios reviewed & revised every summer to insure best practice

44. Scenario Storage Lessons Learned SCENARIO DEVELOPMENT & REVIEW & STORAGE • Shared scenario storage system • “FinalSim” houses all up-dated scenarios - batch file runs every night to load to Laerdal computers