Time Manikin Settings and Changes Desired Learner Actions Actor Cues / Prompts Teaching Points 0-3 min VS now : BP: 130/89 RR: 16 HR: 84 Pulse Ox: 95% LOC:A&O x 3, calm, communicative Physical Status Lungs: normal BS: positive x4 Operator Verbal Sounds: I’m okay, my thigh hurts where they drained that thing. RN Learner: Gown and gloves prior to entering patient room Identifies patient and self Assesses LOC Obtains vital signs Obtains history Checks medication and rate Recognizes vancomycin infusion rate as too rapid Stops vancomycin infusion Nurse on outgoing shift: RN learner: “I have to go pick up my kid from school. I just started the antibiotic, he’s stable, will you just double check everything for me?” Intentional error: allows vancomycin to infuse rapidly via gravity Leaves room in a hurry before RN learner can ask any questions or assess patient Discuss: Importance of maintaining contact isolation. Importance of appropriate handoff procedure Example: Outgoing shift reviews health record with incoming shift, confirming patient background information, relevant health history, drug allergies, treatments/interventions ordered, treatment/interventions given or pending, lab tests, plan of care. The outgoing and incoming shifts should visualize and confirm medicated drips at the bedside. Appropriate Vancomycin infusion rate: infuse over 3-10 min VS change: CHANGE VS FIRST, THEN VERBAL REACTION (agitation, SOB) Sweating, switch on LEDs BP: 110/65 RR: 22 HR: 135 Pulse Ox: 92% RN Learner: Recognizes patient condition is changing Contacts Provider Learner via telephone Communicates patient status to provider using SBAR Provider Learner: and gloves prior to entering patient room If faculty/simulation staff is acting in the role of the provider: Orders: Diphenhydramine75 mg PO Cimetidine 300 mg PO O2 at 2L/ min via NC Enters orders in electronic health record Discuss: Differential diagnoses and symptoms of red man syndrome Etiology of red man syndrome Treatment modalities for red man syndrome 4
LOC:A&O x 3 Operator Verbal Sounds: Becomes agitated and increasingly anxious VS changes: See page 6 for VS changes in response to learner actions Identifies self Examines patient Diagnose red man syndrome Communicates diagnosis and orders with RN learner using SBAR Orders: O2 at 2L/min via NC Diphenhydramine75 mg PO Cimetidine 300 mg PO Enters orders in the electronic health record Discusses diagnosis and plan of care with patient RN Learner Acknowledges orders using closed loop communication Administers: O2 at 2L/min via NC Diphenhydramine 75 mg PO Cimetidine 300 mg PO Continues talking to patient Reassesses patient Communicates patient status and implementation of orders with Provider Learner using closed loop communication Differences between red man syndrome and anaphylaxis Importance of using SBAR and closed loop communication Example of SBAR: S: Mr. Paulson, a patient here in room 1434 is in acute distress, he’s agitated, O2 saturation dropped to 92%, heart rate increased to 135, and developed an erythematous rash on his face. B: He is a 68 year old male admitted last for MRSA infection of a leg wound. He just received IV vancomycin. A: I noticed that the vancomycin was infusing rapidly when he developed the symptoms. I stopped the vancomycin infusion. R: I would like for you to come assess him as soon as possible. When can you get here?
request/action, then 2nd team member confirm request fulfilled/action performed. 13 Contacts provider Does NOT contact provider 0 Contacts provider 2 14 Uses SBAR: Situation Does NOT communicate Situation to provider 0 Communicates Situation to provider partially 1 Communicates Situation to provider completely and accurately 2 15 Uses SBAR: Background Does NOT communicate Background to provider 0 Communicates Background to provider partially 1 Communicates Background to provider completely and accurately 2 16 Uses SBAR: Assessment Does NOT communicate Assessment to provider 0 Communicates Assessment to provider partially 1 Communicates Assessment to provider completely and accurately 2 17 Uses SBAR: Recommendations Does NOT communicate Recommendations to provider 0 Communicates Recommendations Situation to provider partially 1 Communicates Recommendations Situation to provider completely and accurately 2 18 Discusses Interventions with Patient Does NOT discuss interventions with patient 0 Discusses interventions with patient partially 1 Discusses interventions with patient 2 Implementing orders/interventions 19 Administers Benadryl Does NOT administer diphenhydramine 0 Administers diphenhydramine incorrectly 1 Administers diphenhydramine correctly 2 20 Administers Zantac Does NOT administer cimetidine correctly 0 Administers cimetidine incorrectly 1 Administers cimetidine correctly 2 21 Re-assesses patient and vital signs throughout simulation Does NOT re-assess patient and vital signs 0 Re-assess patient some of the time 1 Re-assesses patient and vital signs continually 2 22 Administers Oxygen Does NOT administer oxygen correctly 0 Administers oxygen correctly 2 Highest possible = 44 Total Score: Provider Learner Critical Actions Checklist Competing Team_______________ Red in the Face