Paris Hotel and Casino  Las Vegas, Nevada
Improving Bedside CPR Skills and
Team Skills with In-Situ Simulations
Presented by:
Jennifer Sweeney, MSN, RN, CEN
Advanced Practice Program Coordinator
Center for Advanced Surgery & Simulation
Sarasota Memorial Health Care System
Presenter Disclosure
Information
Jennifer Sweeney, MSN, RN, CEN
Improving Bedside CPR Skills and Team Skills
with In-Situ Simulations.
No relevant financial relationships exist.
Random In-situ Critical
Event Simulation
• Improving CPR skills and teamwork for
providers at the hospital patient’s bedside.
• This presentation will demonstrate the design
and implementation of the program
– Garnering stakeholder support.
– Tools to produce measurable outcomes.
– Results from 12 months of data collection.
Background
• SMHCS is a 806-bed regional medical center.
– 4,000 staff, 802 physicians
• Large simulation center with 8 High fidelity
simulators, 1 Program Coordinator, 0 Simulation
Technicians
• Florida “seasons” make in-lab training difficult to
schedule most of the year.
• Financial constraints necessitated driving the
simulation program out to the bedside.
Problem:
• Needs assessment revealed concern with direct care
providers’ comfort and confidence with recognizing
and responding to emergent patient care situations.
• Concern with cost involved with lengthy simulation
classes, loss of productive time, scheduling concerns,
etc.
• Fear in the first five minutes.
Solution:
• Short critical event scenarios are simulated in the
actual areas these events may take place.
• TeamSTEPPS principles integrated into scenario
planning and debriefing.
• Simulations last no longer than 20 minutes including
pre-briefing, conduction of the simulation, and
debriefing of all providers involved.
• Results shared with the unit educator and manager
for further review, in–depth debriefing, and ongoing
staff education.
TeamSTEPPS:
• Team Strategies and Tools to Enhance
Performance and Patient Safety
• FREE, Evidence-based teamwork system
aimed at optimizing patient outcomes by
improving communication and teamwork skills
among health care professionals.
• http://teamstepps.ahrq.gov/
Scenario Selection
•
•
•
•
•
•
Interdisciplinary
Short critical events
IN-SITU
Impromptu
What scare you the most?
Focus on patient safety and teamwork!
Garnering Support
-
Keep it quick: in and out as fast as possible.
Meaningful: set clear and realistic objectives.
Interprofessional: look for your champions.
Budget neutral: high fidelity, low fidelity, no fidelity.
FOCUSED on PATIENT SAFETY.
Build it (Hype it) and they shall come!
Implementation
Conducted in-situ for no
longer than 20 minutes with
any/all health care team
members working at that time:
- 10 minutes for conduction of the
Video recorded for educational
review at a later time (staff
meeting, huddle, end of shift).
simulated event and 10 minutes for
debriefing of all providers involved.
Debriefing focused on identification
and immediate correction of latent
safety threats and principles of
TeamSTEPPS.
Just do it! The program and
results sell themselves!
Always have “crowd controllers” to
communicate with patients and
visitors during the exercise. Big
crowd pleaser!
RISCE Simulation in OB ECC
Goal: Test new communication plan for
rapidly summoning help to new unit and
overall emergency preparedness of new unit.
MD
RN
RT
Time: 8 minute Scenario, 5 minute Debrief
Debriefing:
Latent Safety Threat Identified:
Operator paged out location
incorrectly causing delay in arrival of
NICU Team. Follow up meeting
scheduled that day to correct.
TeamSTEPPS: Excellent
demonstration of Mutual SupportConcern voiced by physician to
increase speed of compressions.
Team did not respond. Physician
began counting cadence aloud.
Room for improvement noted in use
of call outs and check backs
between Respiratory Therapist and
Nurse.
Evaluation
Tool Selection:
-
Quantitative Data for the number crunchers.
Qualitative data for the emotional impact.
Baseline data to compare to ongoing data.
Look for tools that are already validated, reliable, have been
utilized in other programs, etc.
- TeamSTEPPS tools.
Outcomes
• Post-RISCE participant evaluation tool:
– Perceptions are evaluated per session and for
improvements over time.
• Review of the RISCE simulation video:
– TeamSTEPPS behaviors
• Scored as consistently applied ‘1’, inconsistently applied
‘0.5’, or absent ‘0’.
– BLS/ ACLS guidelines:
• Recommended practice is compared to actual performance.
– Video breakdown
3/29/2012
6/10/2012
9/13/2012
12/16/2012
2/4/2013
Start time to recognition
0
10
10
15
10
Start time to call for help
0
30
10
15
25
Start time to start CPR
50
60
30
42
33
Start to arrival of AED
100
140
65
60
60
Start to use of AED
150
170
95
97
86
Start to Code Blue arrival
210
140
65
180
95
Compressor 1 time before switch
140
220
60
200
150
Time off chest 1
20
40
15
18
20
Time off chest 2
10
30
12
30
10
Time off chest 3
35
Time off chest 4
12
Compressor 2 time before switch
Safety threat 1
Safety threat 2
Safety threat 3
Safety threat 4
20
Order should be
directed to a particular
person, then repeated
back by that person.
long delay from
Poor closed loop
recognition to response communication
long time off chest
Long breaks in chest
compressions
Multiple calls made to
ensure code team and
NICU team were en
route, need better
closed loop
communication
Infant resuscitation
area missing needle
decompression
supplies
Code Blue did not
have badge
access through
new door
RN did not
visually clear
team before
delivering shock.
Questions?
Jennifer Sweeney, MSN, RN, CEN
Sarasota Memorial Health Care System
Jennifer-sweeney@smh.com
941-917-1761
References
• Edelson DP, Litzinger B, Arora V, Walsh D, Salem K, Lauderdale DS,
Vanden Hoek TL, Becker LB, Abella BS. (2008). Improving In-Hospital
Cardiac Arrest Process and Outcomes With Performance Debriefing.
Arch Intern Med.168(10):1063-1069.
• Gillespie BM, Chaboyer W, Murray P. (2010). Enhancing
communication in surgery through team training interventions: a
systematic literature review. AORN J. 92:642-657.
• Halverson AL, Andersson JL, Anderson K, Lombardo J, Park CS,
Rademaker AW, Moorman DW. (2009). Surgical Team Training: The
Northwestern Memorial Hospital Experience. Arch Surg.144(2):107112.
• Siassakos D, Bristow K, Draycott TJ, Angouri J, Hambly H, Winter C,
Crofts JF, Hunt LP, Fox R. (2011). Clinical efficiency in a simulated
emergency and relationship to team behaviours: a multisite crosssectional study. Simul Healthc. 6(3):143-9.