eSimulation in Action at
Kettering Medical Center
Barbara Musgrave, RN, MSN,
CPAN
Kettering Health Network
Kettering, Ohio
Kettering Medical Center
• Kettering Hospital 400-450 beds
• Sycamore Hospital 200 beds
• Kettering Behavior Medical Care 50
beds
All part of the Kettering Health
Network
Objectives
Describe the process of implementing a
comprehensive online staff
development process.
Identify the barriers and advantages for online
learning.
Describe the evolving programs of esimulation
for KMC.
Goal
• Provide a
• cost effective,
• evidence-based,
• user friendly,
• easily accessible method for
staff development and BLS
training.
The Past
Kettering Hospital had 5-6 Education Days
held from January to June.
‘Education Days’ ran from 8am-3 pm until all
nurses’ requirements were met.
Daily attendance was between 200-250
nurses each quarter.
The Past
These were 8 hour days in which staff were
scheduled to attend once a year.
Because of space limitations, the ‘Education
Days’ were held in a rented space off the
hospital campus.
The Past
All staff nurses attending were taken off the unit
schedules or coming to the education days
on their day off.
Thus, patient care staffing was challenging for
many units in addition to budgets for many
managers.
Lunch and break food items were catered in at
an expense to the Professional Development
Department.
BLS
• Required eight to ten instructors each
month
• Subjective view of pass and fail
• Transfer and storage of manikins costly
and time consuming
BLS Training
• 2250 staff required to maintain BLS
competency
• 30 BLS course offerings
• 5 courses per month January – June
• 80 students per course
• 14 BLS Instructors per course offering
Why Online Classes
• Single location and distribution for all
users
• Link resources to internal policies and
reference material
• Easily updated
• Available to all users wherever Internet
access is available
• Manager and administrator time less on
monitoring training
Why Online Classes
• Online allows nurses more time at the
bedside than traditional methods of
education
• Eliminates staffing problems
• Participants finish in less time than lectures
• Educational content is presented in a
consistent manner
Knowledge Based Learning
(Simpson, 2007)
Online Learning
• Definition: content presented via a
computer over the Internet.
• Learners have control and responsibility.
• Large amount of content broken down
into smaller modules.
• Easy transfer of new knowledge to skills
used.
Criteria For Selection of
Software
• Easy Use
• Interactive characters
• Graphics
• Rapid Calculation
• Interest Level
• Content
Adapted from Evalating Computer Assisted Instruction by Christnene Bolwell, 1989, New York: National
League for Nursing.
What We Were Searching For
• One program for annual regulatory
requirements and free CEs (replace
annual education days)
1. BLS (competency and skills)
2. Diverse educational opportunities
available online with CEs
3. Accessible from work or home 24/7
4. Up-to-date and evidence-based
What We Were Searching
For
5. Easily updated
6. Available to all users wherever Internet
access is available
7. Manager and administrator time less on
monitoring training
HealthStream
• Compliance with Annual
Regulatory Requirements for the
Nursing Division
• Provides many free contact hours
• Facilitates competency evaluation
• Facilitates online BLS and ACLS
course
• Provides educational support on
diverse topics.
HealthStream
• Interactive testing for instant
feedback
• Announcement section for specific
hospital news and alerts
• Access 24 hours a day from any
computer
BLS
Laerdal
Medical
Corporation
American
Heart
Association
HealthStream
How Does It Work?
• Can take Part 1 at work or home
• Part 2 completed in BLS Lab
• Mailed BLS card in approximately
2 weeks. Completion of Class
listed on online transcript
Business Plan
A Business Plan had to be
presented to Administration
•Identifying needs of the facility
•Listing initial and long-term costs
•Calculating long-term savings to the
healthcare system
•Recommending a system or systems
The Process of Implementation
• Skill Labs
• 3 campuses
• 6 mannequin sets
• 4 dedicated computers
• Labs accessible 24/7
• Professional Development staff available
• Mon - Fri 0730 – 1800
• Sun 0630 – 1830 and 0930 – 2130 once
monthly
Yea!! I did it.
How Are We Doing- BLS
84.2% rated 5/5 Educational
needs met
Staff Comments Regarding BLS
• “Loved the computer feedback!”
• “Love this. It is more realistic.”
• “I love doing it this way! I feel like I am more prepared
should I need to use my skills.”
• “This is wonderful. I love the hands on experience and
how the computer lets you know how you are doing
through the whole procedure.”
Staff Comments Regarding BLS
• “Great and concise.”
• “I love it! Much better than class. I
received precise feedback from the
computer.”
• “I liked taking the test online…and then
applying it to the mannequin skills. It
made it real.”
What Was Said (Nurses are not shy)
• Some of the skills needed were computer
skills rather than BLS skills, thereby
discriminating against those with poor
computer skills
• Sometimes frustrating, but got through it
none the less. It does give you correct
technique
• I personally didn't like it. I prefer the old
way.
How Are We Doing- Skills Day
Long ‘Nursing Ed’ Days are gone
Replaced with ‘Skills Day’- Check-off on
Restraints and Mock Code’ only
Offered two 12 hour weekdays monthly and
one 12-hour Sunday once a quarter.
95.7% evaluated 5 out of 5 on “Individual
educational needs being met”
Staff Comments of Skills Day
“Very concise and to the point. Nice
experience.”
“Great yearly reminders”
“I prefer the old fashion way when we had
education days. I don’t like everything
cut so short and on the computer”
“Having this on the weekend is great!”
Courses
In last 12 months KHN employees
have completed:
22,607 courses with a total estimated
hour time of 18,276.
1,029 completions of BLS
How Are We Doing—Online
Classes
Does the format meet your needs?
87.6% rated 3 & above out of 5
Does the online learning format save you
time?
70.7% rated 3 & above out of 5
Were your educational needs met?
87.2% rated 3 and above out of 5
Cost Comparison
2008 HeartCode BLS
2007 Traditional BLS
Registered Nurse
$354.38
Registered Nurse
Licensed Practical Nurse
$322.00
Licensed Practical Nurse
$41.00
Nursing Assistant
$244.86
Nursing Assistant
Registered Nurse
$556,376.60
Registered Nurse
$41.00
$41.00
$64,370.00
Licensed Practical Nurse $58,604.00
Licensed Practical Nurse $10,742.00
Nursing Assistant
Nursing Assistant
Total Cost
$64,153.32
$679,133.92
Total Cost
$7,462.00
$82, 574.00
The Final Numbers
• Savings $596,559.92
• Staffing solutions
• No need to schedule nurses off unit
• Staff coverage issues decreased
• Problem of hours not available for all shifts
eliminated.
• Instructors
• Facility
• Equipment
What Was Gained
• Empowerment and Self Governance
• Accessible 24/7
• Self scheduling
• Part 1 completed at home, nursing unit
• Part 2 drop in
• Interactive computer allows for
immediate feedback
• Objective
• Enhanced skills
Compliance with Education
• Managers notified weekly through emails
and reports.
• CNO notified weekly of nursing staff
advancing education through available
courses.
• Collaboration between clinical and
educational practice enhanced with easy
computer access and results.
Positives
• Preceptors access to grades.
• Transcripts organized by skill name, task
name, or completion date.
• Provides easy access to a
comprehensive resource for review of
skills.
• Offers an interactive testing process to
check for competency of skills.
• Increased knowledge and competency.
Challenges
• ‘Computer’ Knowledge
• Expectations of Performance
• “Use Your Full Body Weight”
• “Compress A Little Deeper”
• Word of Mouth (ie: ‘Bad’ News
Travels Fast)
Barriers
• Unsupportive managers
• Staff issues
• Availability of programs
• Family commitments
• Participation on “own” time
• Computer savvy
Added Bonus
• Less than 14% successful resuscitation rate
in 2007
• 27% successful resuscitation rate in 2008
• 32% successful resuscitation rate for 2009
“Today I made a difference.”
Evolving…
ACLS available—Where to go
from here?
ACLS 2008
• 50 licenses purchased for trial
• Users were staff nurses, medical
residents, and clinical nurse
managers
• Assessable in Professional
Development Department only for
Part 1 and Part 2
• All 50 licenses completed with
passing rate
Learning Needs
• 567 Nurses for recertification of ACLS in
2009
• KMC consists of KH, SH, and KBMC
• KH consists of 4 ICUs, 6 Med/Surg with full
telemetry, 2 Med with partial telemetry,
only one Meg/Surg without
• SH consists of 1 ICU and 3 Med/Surg with
telemetry throughout facility
• KBMC consists of 1 adult and 1 youth unit
The Past
• Quarterly ACLS class offered for
primary ( 2-8 hour days) and
recertification (4-6 hours)
• Nurses scheduled off unit or on day
off
• Limited availability in classes –
usually 20 participant limit
• Difficult to schedule-few classes
offered
Past Costs
• $40 purchase for live class for each
participant
• 4-5 instructors within the
organization with EMTs from
community
• Staff paid for hours of class
• Frequently overtime used for
patient care on cardiac and ICU
units for patient care coverage
ACLS 2009
• Assessable from home or hospital
• Requires Internet access, no dial up
• No personal cost for nurses
• 12 free CEs upon completion
• 10 computers available in Professional
Development for use for Part 1
• Part 1 obtainable 24/7 from home or work
• Part 2 for skills on site with mannequins
available 730-1700
ACLS 2009 Benefits
• No time waiting for available class
• Assignment for new hires instantly
• Over 30 days for completion of course
• HeartCode book online in program
• Participants can practice at their own rate
• No costs for instructors, nurses hours in
class, patient care hours for coverage
while at class
Barriers
• Access from some user’s homes
Computer “literacy” challenged for
some staff nurses
• Hours of online class longer than
time spent in classroom setting
from the past program
• Poor Internet access in some
homes
2009 ACLS
• 319 courses assigned
• 77 completed
• 24.14%
Different learner types
• Visual – primarily through written
word
• Auditory-listening required, focuses
on words
• Kinesthetic-learns by doing,
practice and hands on
opportunities work best
Notter, 2002
Generational differences
• Traditionalists-written form is preference 5% of workforce
• Baby Boomers-loves meetings-45% of the
workforce
• Generation X-video game pros, PCs-40%
of the workforce
• Generation Y-grew on the Internet, e-mail,
Facebook-10% of the workforce
Dittman, 2005
KMC Gains
• Pass/Fail measurable
• Increase individual critical thinking
skills
• Increases nurse’s computer skills
• Average age of nurses on all units
11% under 30 y.o., 70% greater
than 40 y.o. *
• Objective grading vs. subjective
*2008 ANA NDNQI RN Survey Report
Evolving…
Essentials of Critical Care Orientation
64 Contact Hours
Developed by the American Association of
Critical-Care Nurses (AACN™)
Staff member has one year to complete
25 licenses purchased as trial phase
Success of ECCO Program
• Overwhelming request for
program- 20+ nurses
• Completion of program in 12
months
• Certification rate for CCRN
from participants
Evolving….
Pediatric Advanced Life Support Course
Starting in Second Quarter 2009
Evolving…
• Classes have been ‘bundled’ to target
specific patient populations, ie: Stroke,
Cardiac
• Simulation mannequin to enhance BLS, ACLS,
and ECCO programs
• More hands-on practice to promote critical
thinking skills
Questions?
• Contact Barbara Musgrave at
Barbara. Musgrave @khnetwork.org
• 937.298.3399 ext. 57342