Simulation and Health Care: The METI Solution

1. Simulation and Health Care:The METI Solution Judy Johnson-Russell Ed.D., RN Clinical Educator Education and Training Services Medical Education Technologies, Inc Professor Emerita Texas Woman’s University - Dallas Medical Education Technologies, Inc.

2. It’s a new world! • Nation is facing a crisis in health care quality and safety presenting many challenges • Health care agencies • Schools preparing health care practitioners Medical Education Technologies, Inc.

3. Common Challenges • Shortage of Qualified Graduates and Faculty • Critical Thinking, Diagnostic Reasoning, Problem Solving • Prioritization • Safety • Teamwork and Interdependence • Communication and Collaboration • Skills, Technology, and Use of Resources Medical Education Technologies, Inc.

4. Meeting the Challenges with METI • All of these challenges can be addressed with the right simulators, the right simulated clinical experiences (SCEs) and the right equipment • METI family of simulators • Program for Nursing Curriculum Integration • Nurse Residency Program • METIVision • eDose Medical Education Technologies, Inc.

5. Emergency Care Simulators (ECS) • Adult patient mannequin (ECS) • Length: 5 feet, 11 inches (180 cm) • Weight: 75 pounds (34 kg) • Pediatric patient mannequin (PediaSIM-ECS) • Length: 4 feet (122 cm) • Weight: 38 pound (17 kg) • Infant patient mannequin (BabySIM) • Length: 26 inches (65 cm) • Weight: 16 pounds (7 kg) Medical Education Technologies, Inc.

6. METI Simulators • With these simulators you have a patient that: • Blinks, variable pupil size, chest moves with respirations • Normal/Abnormal Heart, Lung, Bowel Sounds • All Pulses, Blood pressure measurement • Waveform monitors can be used or disabled to include: ECG, SpO2, Temperature, NIBP, arterial Line, CVP, Pulmonary Artery Catheter, EtCO2, Thermodilution Cardiac Output. Medical Education Technologies, Inc.

7. METI Simulators • IV’s and IM Injections • Intubation, Tracheotomy, Chest Tube placement and maintenance • Use of various forms of O2 may be simulated • Pacing and defibrillation • Exchangeable Genitalia • Continuous or catheterized urinary output • Moulage with wounds, edema, emesis, stools, bleeding, cyanosis, all types of trauma, pregnancy and postpartum Medical Education Technologies, Inc.

8. iStan • Adult patient mannequin • Length: 5 feet, 10 inches (178 cm) • Weight: 100 pounds (45.5 kg) • Wireless & Tetherless • Controlled wirelessly and the mannequin is tetherless • Fully Self Contained • Blood, gases and fluids are 100% on-board the simulator • Realistic Suits of Skin • Ability to self-seal • True Articulated Motion • Fully Loaded • Same features as ECS • Realistic bodily secretions & sweating • Jugular distention • Trismus & Jaw thrust Medical Education Technologies, Inc.

9. METI Difference: The METI Family • METI Simulators contain modeled patients to represent the physiologic responses for: • Standard Man (woman), Healthy person, 33 yrs old • Unhealthy Middle Aged person (male or female) • Stannette: Normal full term pregnant female • Standard Elderly male or female • Soldier, extremely fit, hypermetabolic 20 year old • The child, PediaSIM • The infant, BabySIM Medical Education Technologies, Inc.

10. The METI Difference • Preprogrammed scenarios (simulated clinical experiences) for different levels of students • Program for Nursing Curriculum Integration (PNCI) v.4 100 Adult, Child, Infant • PNCI Choice Modules: limited number from the PNCI • Adult Nursing (20 SCEs) • Pediatric Nursing (16 SCEs) • Infant Nursing (8 SCEs) • Nurse Residency Program Medical Education Technologies, Inc.

11. Program for Nursing Curriculum Integration (PNCI) • 100 Simulated Clinical Experiences (SCEsTM) • 76 adult, 16 child and 8 baby • Patients are all ages, male and females • From various cultural backgrounds • Wide variety of conditions, acute and chronic, all stages of illness from emergency room to discharge • In a variety of settings, both hospital and non hospital (rehab, health fair) • Different interventions, skills, medications, safety issues, communications, health beliefs and ethical issues are imbedded in the SCEs Medical Education Technologies, Inc.

12. 100 Simulated Clinical Experiences (SCEs) • Semester I Health Assessment - 9 SCEs Skill Validation - 1 SCE • Semester II Adult Medical Surgical - 18 SCEs Childbearing - 5 SCEs Medical Education Technologies, Inc.

13. 100 Simulated Clinical Experiences (SCEs) • Semester III Chronic Care - 11 SCEs Community Care - 5 SCEs • Semester IV Adult High Acuity Medical Surgical - 9 SCEs Adult Critical Care - 17 SCEs Leadership/Management – 1 Medical Education Technologies, Inc.

14. 100 Simulated Clinical Experiences (SCEs) • Pediatrics PediaSIM - 16 SCEs BabySIM - 8 SCEs • Tools SBAR Medical Education Technologies, Inc.

16. Simulated Clinical Experiences • Components include • Synopsis • Learning objectives with cognitive taxonomy • Patient background information and history • Healthcare provider’s orders • Questions for learner preparation • Simulator set-up and instructor notes • Scenario including simulator enabled findings, minimum behaviors expected and prompts, questions and teaching points. • All evidence-based and updated every 3 yrs Medical Education Technologies, Inc.

17. Simulated Clinical Experience Process Tool

18. Simulated Clinical Experience Process Tool

19. Outpatient, Health Promotion .

20. All Inpatient Areas are Represented Medical Education Technologies, Inc.

21. Nurse Residency Program • Developed at Dartmouth-Hitchcock utilizing simulation • Graduate nurse residency orientation program focused on: • Skill-based learning • Critical thinking • Human factors engineering • Patient safety Medical Education Technologies, Inc.

22. Nurse Residency Program • Program includes: • Weekly didactic presentations • Weekly structured simulation experiences • Clinical time with a qualified preceptor • Self directed learning materials • Simulated clinical experiences include concepts of patient safety, including human factors, communication, resource management and situational awareness Medical Education Technologies, Inc.

24. Nurse Residency Program • Dartmouth-Hitchcock was able to: • Decrease orientation time of new nurses from 22-34 weeks to 12 weeks • Decrease turnover by 70% • Increase retention by 75% after 18 months • Decrease vacancy rate to 3% • Eliminate reliance on traveling nurses • Keep nurses for 18-24 months—”For Life” Medical Education Technologies, Inc.

25. Nurse Residency Program • “Found that a Nurse Residency Program that incorporates simulation increases new grads readiness for independent clinical practice and provides a more predictable process for acquisition of skills” Beyea, von Reyn, Slattery (2007). A Nurse residency program for competency development using human patient simulation. Journal for Nurses in Staff Development 23 (2) 77-82. Medical Education Technologies, Inc.

26. Meeting the Challenges with Simulation • A Simulator and the Simulated Clinical Experiences (SCEs) provide you with the opportunity to meet the needs of your learner, whatever they may be • Youdecide on the patient situation in need of interventions and the level of the students • Focus on learner’s needs, not the patient’s • You have the timeto facilitate critical thinking, diagnostic reasoning and problem solving • Patient safety is not an issue • Retention improvesas students see the results of their actions (experiential learning) Medical Education Technologies, Inc.

27. All SCEs Provide the Possibility for Meeting Multiple Objectives with Multiple Learners

28. www.meti.com/mymeti_recipe.htm • Recipes for Disasters Cookbook • Blood RecipesCardiovascular RecipesEnvironment RecipesGastrointestinal Recipes Respiratory Recipes Sputum RecipesUrine RecipesWound Recipes Medical Education Technologies, Inc.

29. An Integrated Audio / Video SolutionDeveloped in collaboration with: Medical Education Technologies, Inc.

30. METIVision • Web-based system that fully integrates and synchronizes the simulation experience • Audio and video • Physiological data • Waveform display • Simulation event logs • Captured real-time annotations • Real time or recorded Medical Education Technologies, Inc.

31. METIVision

32. eDose • Innovative, web-based learning and assessment environment that uses screen-based simulations to facilitate understanding and mastery of the skills needed to safely and accurately perform medication dosage calculations Medical Education Technologies, Inc.

33. Facilitating Competency in Nursing Numeracy:A shift from abstract to authentic learning environments…

34. eDose • Based on a sound theoretical base of research that identified three core skills required to understand and accurately solve medication dosage calculation problems • Understand and correctly set up the problem to be solved • Accurately compute the numerical calculation • Understand the design of the medication measurement and delivery device, and accurately measure the dose to be administered Medical Education Technologies, Inc.

35. X 2 = 2ml eDose • Understand the design of the medication measurement & delivery device; accurately measure the dose to be administered • Understand & correctly set up the problem to be solved • Accurately compute the numerical calculation Medical Education Technologies, Inc.

36. eDose • Components of eDose • Medication Dosage Calculation Skills • Authentic Diagnostic Assessment • Authentic Assessment Medical Education Technologies, Inc.

37. eDose Student Path Practitioner Path Exposure toAuthentic Assessment to audit level of competence Authentic Assessment Exposure toAuthentic Assessment prior to graduation Entry Exposure toAuthentic Diagnostic Assessment to identify specific areas of skill deficit Exposure toAuthentic Diagnostic Assessment at pre-determined points in the curriculum Authentic Diagnostic Assessment Remedial skill development within the MDCS learning environment Begin skill development within the MDCS learning environment MDCS Learning Environment Entry Identify start-point ability against which progress can be measured Fundamental Numeracy Assessment

38. Pre-Registration Medication Dosage Calculation Diagnostic Assessment Programme Point of Graduation Level Assessment Graduation Level Assessment and Retrieval Graduation Level Authentic Diagnostic Assessment: Domain Specific Unit Dose/Sub & Multiple Unit Dose/ Complex Dose Problems/Conversion of SI Units Diagnostic Assessments Medication Dosage & Administration Management Assessment Medication Dosage & Administration Management Assessment Diagnostic Level Assessment Authentic Diagnostic Assessment: Generic Unit Dose/Sub & Multiple Unit Dose Exposure to Structured and Constructivist Centered Medication Dosage Learning & Diagnostic Assessment Environments Exposure Education Program Structured Education Program Tablet & Capsule Tablet & Capsule Tablet & Capsule Liquid Medicines Liquid Medicines Liquid Medicines Injections Injections Injections IVI IVI IVI Entry to Nursing Program Entry Level Assessment Student Pathway within the eDose Medication Dosage Calculation Learning and Diagnostic Assessment Program Medication Dosage Assessment

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42. Easy to Administer METI eDose Assessments are easy for faculty to set up and administer. Just develop your rubric and eDose does the rest.

43. Well Structured & Diagnostic Rubric Medication Dosages iV Volume & Rate Total Tablet & Capsule Liquid Medicine Injection IV Infusions Total Ml per Hour 10 10 Conversion SI Units 2 2 2 6 Complex Arithmetic 2 2 2 6 Sub & Multiple Unit Dose 3 3 3 9 Drops per Minute 10 10 Unit Dose 3 3 3 9 Total 10 10 10 30 Total 20 20 Grand Total: Questions = 50 30 + 20 = 50 Grand Total: Questions = 50 30 + 20 = 50 Grand Total: Point Score = 100 Each question consists of two phases: • Problem Comprehension & Set-Up (1 Point) • Problem Computation (1 Point) 60 + 40 = 100 • The assessment tool should: • Provide a unique set of questions with a consistent level of difficulty • Provide a structured range of complexity • Take place within a defined framework, at points by which students can be effectively prepared, while allowing time for supportive remediation. (Hodgen & Wiliam, 2006)

44. Report Interpretation

46. "The difficulty lies not so much in developing new ideas as in escaping from old ones" John Maynard Keynes Medical Education Technologies, Inc.

47. Questions and Discussion jjohnsonrussell@meti.com Medical Education Technologies, Inc.