SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Name Post op care/sepsis: Knee Replacement (Resident RN)
Program/Curriculum Specific Objectives:
Recognizes and reports signs and symptoms of post-operative complications and
potential sepsis. Identifies effectiveness of interventions to treat sepsis. Assesses and
treats pain appropriately. Administers PO meds and IV fluids safely and correctly.
Measurable Objectives (minimum 2, maximum 10)
1. Performs head to toe physical assessment, including VS and mental status
2. Performs focused assessment of knee and incision
3. Assesses pain and makes treatment decisions based on assessment findings
4. Recognizes abnormal assessment findings
5. Identifies signs and symptoms of SIRS, sepsis.
6. Applies the nursing process in clinical decision making
7. Demonstrates caring and advocacy for the patient
8. Requests assistance from available unit resources
9. Maintains effective closed loop communication with all members of health care team
10.Administers PO pain medication, IV antibiotics and fluids safely and correctly using
the 6 rights.
Instructor’s Name Kyra McCoy Edmonds Community College
Robin Thomas Swedish Medical Center
Date Submitted Spring 2013
Will There Be Any Pre-Simulation Lecture?
Yes
Expected Scenario Time 30-40 min Expected Debrief Time
60 min
Report and Information Provided To Participants Prior To Simulation
Handoff from the ED:
Patient demographic information: (as below)
Assessment:
VS:
T P R BP 36.5, 105, 20, 110/62
Neuro:
Alert, oriented to person and place. New onset of disorientation to time and
date that started today. Moves all extremities, left leg movement painful.
Respiratory: Respirations even/unlabored, lungs clear. Oxygen saturation 94%. No
oxygen therapy
Cardiac:
Regular rhythm, rate 100-110. Skin is warm and dry.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
1
SIMULATION DESIGN & PLANNING TEMPLATE
GI/GU
Had been tolerating diet well up until today. Patient states she does not
have any appetite. Last bowel movement yesterday. Reported from SNF
that she gets up to commode with assist of one. Has not voided in the ED.
Skin
All potential pressure areas intact. . L knee circumference 6 cm. greater
than R, incision line reddened, tender and warm. No drainage noted.
Pain
Rates as 2 -3 on scale 0-10. At the SNF, was receiving Percocet one tablet
every 4-6 hours. Last was right before coming to ER 4 hours ago
Mobility: Using walker for assistance when getting out of bed and needs assist of 1.
Has been having physical therapy twice per day but unable to do it today
because of increased pain, swelling, and decreased ROM L knee.
Lines:
20 gauge IV started in right antecubital vein. 0.9% Normal saline infusing
at 100 cc/hr.
Plan: IV antibiotics for wound infection
Labs:
Na 138, Potassium 4.2, Chloride 101, Glucose 110, BUN 20, Creatinine 0.7
WBC 11.0 (with a shift to the left), Hgb 10.4, HCT 31
MAR Medications:
Lisinopril 20 mg PO once daily
Percocet (oxycodone 5 mg APAP 325 mg) 1-2 tablets PO prn every 6 hours
Acetaminophen 325mg 1-2 tablets PO prn every 4 hours
Docusate sodium 100 mg PO twice daily
0.9% NS IV at 100 mL/hr
Ceftriaxone 2 gram/50 cc NS now and IVPB once daily
Patient Information
Patient Name: Rose Henderson
Gender: female
Age: 70
Birth date:, 02/13/1943
Height: 67 in
Weight: 72 kg
ID band MR #00001234 Acct. # 1198765432
Hx. Present Illness: Had total left knee replacement done 6 days ago. Admitted to the
local skilled nursing facility two days ago for postoperative rehabilitation and
strengthening prior to going to own home. Was unable to participate in physical therapy
at skilled nursing facility today due to increased left knee pain, increased swelling, and
decreased ROM. Today there has been a change in her level of consciousness
(disorientation to day and time).
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
2
SIMULATION DESIGN & PLANNING TEMPLATE
Social History:
Widow, lives alone
Support System: daughter
Immunizations: current
Past medical history:
Religion:
Christian
Allergies:
none
Attending Physician:
Michael Johnson
Degenerative Joint Disease, Hypertension
Physical description of how you want the manikin to present at start of scenario?
Moulage:
Add picture here:
Swollen, warm, and reddened stapled incision line on left knee. Wound 8 inches long
and circumference of L knee is 6cm larger than the R.
http://www.topnews.in/health/knee-replacement-surgeries-take-more-time-conduct-overweight-patients-210900
Assignment Of Roles (Please indicate below roles to be assigned):
X
X
X
X
X
Primary Nurse (Resident RN)
Secondary Nurse
RN charge
Observer(s)
Other: RRT member
X Physician (on phone)
X RN preceptor (instructor)
X Family Member (daughter on phone)
X ICU RN (on phone)(instructor)
Important Information Related To Roles:
Instructor to role play the RN preceptor, charge RN, family member (on phone) and physician (on
phone).
Second resident could be observer or Secondary RN and family member in person, depending on the
size of the residency group.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
3
SIMULATION DESIGN & PLANNING TEMPLATE
Fidelity (choose all that apply to this simulation)
Setting/Environment
ER
X Med-Surg
Props:
Equipment attached to manikin:
X Primary IV Fluid 0.9% NS running at 100 ml/hr
X IV pump for NS and for IVPB antibiotic
X O2 nasal cannula available
X ID band
X Anti-embolism stockings
Equipment available in room:
X Bedside commode
X Incentive Spirometer
X IV tubing
X IVPB tubing
X IV pump
Other Props:
Walker
Medications and Fluids:
X Oral Meds Meds Percocet(oxycodone 5 mg
acetaminophen 325 mg) , acetaminophen 325 mg
X IV Fluids 1L.0.9% NS primary, 500 ml 0.9% NS
for bolus
X IVPB ceftriaxone 2 gm/50 ml NS over 30 min
Diagnostics Available:
X Labs Values
Documentation Forms:
X Admit Orders
X MAR
X ER Record
Recommended Mode for Simulation
X Manual/Programmed Hybrid
Manikin to be used hi fidelity Manikin #
Significant Lab Values see attached sheet for labs
Physician Orders see attached
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
4
SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Progression Outline
The first phase of the scenario reflects the dialogue and cues
Patient Preceptor
Initial Amount
Verbalization
Time in Initial
(Pt/Manikin
Stage- 5 mins
Cues)
Not sure what
STATE 1
day or time it
Resident RN
is
enters room and
begins admission
Changes from ED
Pain worse
handoff report in
than yesterday
RED
6/10, L knee,
Baseline Vital Signs throbbing, no
T PR 36.2, 105, 20
radiation, very
BP 105/62
little relief
SPO2 94%
from pain
Cardiac Rhythm ST meds, hurts at
Breath Sounds clear rest, gets
Heart Sounds S1 S2 worse with
Abdominal Sounds movement
active in 4 quads
Other Symptoms:
Can’t move L
Disoriented to time, knee much,
lethargic
can’t
Pain 6/10, swelling straighten it
in L knee 6cm
out at all
greater than R. L
knee incision
red/warm
Eyes open, half
closed
Trending:
VS over time
HR increases and
BP decreases
Expected
Interventions
Alternate or Incorrect
Treatment Choice
That Will Affect Outcome
1. No pain assessment or
incomplete assessment
Confederate
Actions/Additional
Role Player Cues
1. Pt continues to moan
and guard knee, heart
rate goes up to 110
2. Determine
last dose of
pain meds
2. does not check MAR for
last dose or for orders
2. Asks when she can
have more meds
3. Head to toe
assessment
with mental
status
3. No mental status
assessment
3. Pt asks what day or
time it is, asks where
daughter is
4. a) Measure
L knee
circumference
and compare
to previous
measurement
b) Assess
incision and
surrounding
skin
c) Evaluate
ROM and
compare to
previous
4. No focused assessment of
L knee
4. Pt asks how her knee
looks
RN preceptor comes in
to check on status of
knee
5. Prepare and
administer
pain med
5. a)Does not administer
pain med
b) Administers incorrect
pain med (gives confused pt
narcotics)
5. a) Pt continues to
moan, complain, cries
out
b) Pt becomes more
confused and sleepy
6. Prepare and
administer
6. Does not administer IVPB 6. RN preceptor checks
on status of antibiotic
1. Complete
VS, pain
assessment at
rest and with
movement
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
5
SIMULATION DESIGN & PLANNING TEMPLATE
IVPB
antibiotic
Scenario Progression Outline
Initial Amount
Time in Initial
Stage- 5 mins
STATE 2
STATE 3 (after
fluid bolus)
Verbalization
(Pt/Manikin
Cues)
Expected
Interventions
1. RN resident
returns to
reassess pain
relief and
finds pt
condition and
VS
deteriorating
Alternate or Incorrect
Treatment Choice
That Will Affect Outcome
1. a) Does not do a complete
assessment
b) does not recognize
changes
Confederate
Actions/Additional
Role Player Cues
1. RN preceptor comes
in and asks how things
are going
2. Calls MD to 2. Does not call MD
report changes
and
recommends
fluids and O2
2. Preceptor asks what
resident thinks they
should do
3. Get orders
3. Does not administer bolus
for O2 and
correctly or in a timely
administers IV fashion
fluid bolus
3. Preceptor asks if
resident wants help
with the IV
4. Delegates
where
appropriate
4. Does not ask for help or
delegate
4. Preceptor or
secondary nurse offers
help
1. Resident
RN returns to
reassess pt and
finds VS
deteriorating
1. a) Does not do a complete
assessment
b) does not recognize
changes
1. RN preceptor comes
in and asks how things
are going
2. Notifies
preceptor and
charge nurse
of changes
2. Does not notify preceptor
and/or charge nurse of
changes
2. Preceptor checks in
and asks what resident
thinks they should do
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
6
SIMULATION DESIGN & PLANNING TEMPLATE
3. Calls RRT
and MD or
delegates
these tasks
3. Does not notify RRT
and/or call MD
3. Preceptor continues
to ask questions and
coach, asks what
resident thinks they
should do
5. Prepares pt
or transfer (or
delegates this)
5. Does not prepare pt for
transfer and/or delegate this
task
5. Preceptor asks if
resident needs help
6. Calls report
to ICU
6. Does not call report
7. Supports pt
throughout
7. Does not support pt
6. Preceptor checks in
to see if report has been
called
7. Preceptor come in
and asks how patient is
doing, pt asks what is
going on etc
8. Preceptor asks about
daughter, pt asks for
daughter
4. Receives
orders for
transfer
8. Calls
daughter with
an update on
her mom’s
condition and
plan
8. Does not call daughter
The next phase reflects the nursing process for this patient and incorrect
or alternate process choices .
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
7
SIMULATION DESIGN & PLANNING TEMPLATE
Correct Treatment Choice: complete pain
assessment and treatment State 1
Timing Sequence
Expected
10 min
Interventions
Baseline Vital Signs 1. Complete pain
No Change
assessment: location,
T PR 36.5, 105, 20
intensity, quality,
BP 100/62
duration,
SPO2 94%
aggravating/relieving
Cardiac Rhythm ST
factors
Breath Sounds clear
Heart Sounds S1 S2
2. Consider changes
Abdominal Sounds
in level of
active in 4 quads
consciousness when
deciding which pain
Other Symptoms:
Disoriented to date
med to give
and time
Within 10 min:
1. Explains rationale
Verbalization:
Pain worse than
for giving plain
yesterday 6/10, L
APAP to patient
knee, throbbing, no
instead of Percocet
radiation, very little
relief from pain
2. Gives
meds, gets worse
Acetaminophen 325
with movement
mg- 2tabs PO
Can’t move L knee
much, can’t
3. Considers nonstraighten it out at al pharmacologic
methods of pain
Pain level decreases relief such as ice and
elevation
to 2/10 after APAP
is given l
Alternate or Incorrect Treatment choice:
incomplete or no pain assessment State 1A
Timing Sequence
Expected
10 min
Interventions
No pain assessment
Baseline Vital Signs
Increase in HR
or incomplete
T PR 36.5, 110, 20
assessment after
BP 100/62
first 10 minutes
SPO2 94%
Cardiac Rhythm ST
After first 10 min:
Breath Sounds clear
RN preceptor
Heart Sounds S1 S2
comes in and asks
Abdominal Sounds
how the pt is doing
active in 4 quads
Other Symptoms:
Disoriented to date and
time
Verbalization:
Pt moans, complains of
pain, asks when she can
have more pain meds
Alternate or Incorrect Treatment choice:
Gives Percocet State 1B
Timing Sequence
Expected
10 min
Interventions
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
8
SIMULATION DESIGN & PLANNING TEMPLATE
Baseline Vital Signs
Decrease in HR
T PR 36.5, 100, 20
BP 100/62
SPO2 94%
Cardiac Rhythm ST
Breath Sounds clear
Heart Sounds S1 S2
Abdominal Sounds
active in 4 quads
Other Symptoms:
Increased
disorientation to time
and place, sleepy and
difficult to arouse
Verbalization:
Where am I? What day
is it? Who are you? Etc.
Gives Percocet
RN preceptor helps
resident problems
solve decrease in
LOC
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
9
SIMULATION DESIGN & PLANNING TEMPLATE
Correct Treatment Choice: Focused
assessment knee & incision State 1 continues
Timing Sequence
Expected
10 min
Interventions
1. Assess incision
Baseline Vital Signs
No Change
and surrounding
T PR 36.5, 105, 20BP
tissue for color,
100/62
warmth, swelling,
SPO2 94%
drainage, measure
Cardiac Rhythm ST
circumference
Breath Sounds clear
and compare to
Heart Sounds S1 S2
previous value
Abdominal Sounds
and R knee,
active in 4 quads
2. assess ROM,
Other Symptoms:
Pain 6/10,/increased
include data
swelling in L knee 6 cm collection re;
greater than R, L knee
neuro circ check
incision red/warm, no
of foot and
drainage, brisk
Homan’s sign
capillary refill, 2+
pedal pulses, foot /calf
3. Shares
same temp as rest of
concerns for post
skin, no pain in calf,
op infection
moves feet without pain progressing to
sepsis/SIRS with
Verbalization
Pain worse than
RN preceptor
yesterday 6/10, L knee,
pain worse at incision
line, throbbing, no
radiation, very little
relief from pain meds,
gets worse with
movement, no pain in
calf
Alternate or Incorrect Treatment choice: no
or incomplete focused assessment of knee or
incision
Timing Sequence
Expected
10
Interventions
No focused
Baseline Vital Signs
STATE 1C
assessment or
T PR 36.5, 110, 24
incomplete
BP 96/62
assessment within
SPO2 92%
first 10 min
Cardiac Rhythm ST
Breath Sounds clear
After first 10 min:
Heart Sounds S1 S2
RN preceptor
Abdominal Sounds
comes in and asks
active in 4 quads
how the pt is doing
Other Symptoms:
Increased agitation and
confusion
Verbalization:
What is wrong? What is
happening? Why isn’t
my knee getting better?
Pain level decreases to
2/10 after APAP is
given
Pain level decreases to
2/10 after APAP is
given
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
10
SIMULATION DESIGN & PLANNING TEMPLATE
Correct Treatment Choice: Administer IVBP
antibiotic State 1 continues
Timing Sequence
Expected
5 min
Interventions
Administers
Baseline Vital Signs
No Change
Ceftriaxone 2
T PR 36.5, 105, 20BP
grams/50 ml NS
100/62
over 30 min IVPB
SPO2 94%
Cardiac Rhythm ST
Breath Sounds clear
Heart Sounds S1 S2
Abdominal Sounds
active in 4 quads
Alternate or Incorrect Treatment choice:
does not administer IVPB antibiotic State 1D
Timing Sequence
Expected
5 min
Interventions
Does not
Baseline Vital Signs
No Change
administer IVPB
T PR 36.5, 105, 20BP
ceftriaxone
100/62
SPO2 94%
After 5 min:
Cardiac Rhythm ST
RN preceptor
Breath Sounds clear
checks in on pt
Heart Sounds S1 S2
condition and
Abdominal Sounds
status of antibiotic
active in 4 quads
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
11
SIMULATION DESIGN & PLANNING TEMPLATE
STATE 2
RN resident returns to reassess pt. VS have
changed with an increase in HR, RR and
decrease in BP and O2 sats.
Correct Treatment Choice: call MD to report
change in status and recommend fluids and
oxygen
Timing Sequence
Expected
10 min
Interventions
Baseline Vital Signs
1. Calls MD,
STATE 2
reports changes in
T PR 36.5, 110, 22
pt condition
BP 96/62
SPO2 92%
2. Recommends
Cardiac Rhythm ST
fluids and
Breath Sounds clear
supplemental
Heart Sounds S1 S2
oxygen
Abdominal Sounds
active in 4 quads
3. Receives orders
Other Symptoms:
for and
Confusion and lethargy administers fluid
continue
bolus of 500 ml
Verbalization
0.9 NS over 30
Continues to be
min and oxygen
confused- where am I?
@2 liters per
complains of feeling
nasal cannula
cold
(titrate to keep
sats above 92%)
Pain level decreases to
4. Delegates to
2/10 after APAP is
other RNs as
given
needed
STATE 2A
RN resident returns to reassess pt. VS have
changed with an increase in HR, RR and
decrease in BP and O2 sats.
Alternate or Incorrect Treatment choice:
does not call MD to report changes
Timing Sequence
Expected
5 min
Interventions
Baseline Vital Signs
Does not call MD
STATE 2
to report changes
T PR 36.5, 110, 22
BP 96/62
After 5 min:
SPO2 92%
RN preceptor
Cardiac Rhythm ST
checks in on pt
Breath Sounds clear
condition
Heart Sounds S1 S2
Abdominal Sounds
active in 4 quads
Other Symptoms:
Confusion and lethargy
continue
Verbalization
Continues to be
confused- where am I?
What is going on? What
are you doing?
complains of feeling
cold
Pain level decreases to
2/10 after APAP is
given
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
12
SIMULATION DESIGN & PLANNING TEMPLATE
STATE 2B
RN resident returns to reassess pt. VS have
changed with an increase in HR, RR and
decrease in BP and O2 sats.
Alternate or Incorrect Treatment choice:
does not ask for help or delegate
Timing Sequence
Expected
5 min
Interventions
Baseline Vital Signs
Does not ask
STATE 2B
preceptor or other
T PR 36.5, 110, 22
RNs for help or
BP 96/62
delegate
SPO2 92%
Cardiac Rhythm ST
After 5 min:
Breath Sounds clear
RN preceptor
Heart Sounds S1 S2
checks in on pt
Abdominal Sounds
condition
active in 4 quads
Other Symptoms:
Confusion and lethargy
continue
Verbalization
Continues to be
confused, What is going
on? What are you
doing? complains of
feeling cold
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
13
SIMULATION DESIGN & PLANNING TEMPLATE
STATE 3 (after fluid bolus)
RN resident returns to reassess pt. VS have
changed with an increase in HR, RR and
decrease in mental status, BP and O2 sats.
Correct Treatment Choice: Notify preceptor
and charge nurse of changes, call RRT, call
MD to report change in status, increase O2
Timing Sequence
Expected
10 min
Interventions
Baseline Vital Signs
1. Turns up O2 to
STATE 3
3liters.
T PR 36.5, 115, 24
BP 90/60
2. Notifies RN
SPO2 91%
preceptor and
Cardiac Rhythm ST
charge nurse of
Breath Sounds clear
changes,
Heart Sounds S1 S2
Abdominal Sounds
3. Calls RRT (or
active in 4 quads
delegates this)
Other Symptoms:
Confusion increased
4. Calls MD,
(disoriented to place and reports changes in
time), pain and lethargy pt condition
continues
5. Receives orders
Verbalization
Where am I? What is
to transfer pt to
happening?
ICU
6. Delegates to
other RNs as
needed
STATE 3 A(after fluid bolus)
RN resident returns to reassess pt. VS have
changed with an increase in HR, RR and
decrease in mental status, BP and O2 sats.
Alternate or Incorrect Treatment choice:
does notify preceptor or charge RN
Timing Sequence
Expected
5 min
Interventions
Baseline Vital Signs
Does not notify
STATE 3A
preceptor or charge
T PR 36.5, 115, 24
nurse of changes
BP 90/60
SPO2 91%
After 5 min:
Cardiac Rhythm ST
RN preceptor
Breath Sounds clear
checks in on pt
Heart Sounds S1 S2
condition
Abdominal Sounds
active in 4 quads
Other Symptoms:
Confusion increased
(disoriented to place
and time), pain and
lethargy continues
Verbalization
Where am I? What is
happening?
Alternate or Incorrect Treatment choice:
does not call RRT or MD
Timing Sequence
Expected
5 min
Interventions
Baseline Vital Signs
Does not call RRT,
STATE 3B
MD or delegate
these tasks
After 5 min:
RN preceptor
checks in on pt
condition
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
14
SIMULATION DESIGN & PLANNING TEMPLATE
RRT member Arrives
Correct Treatment Choice: Prepare pt for
transfer to ICU and call report
Timing Sequence
Expected
5 min
Interventions
Baseline Vital Signs
1.Gives report to
STATE 3 continues
RRT member
T PR 36.5, 115, 24
using ISBAR
BP 90/60
SPO2 91%
2. Prepares pt
Cardiac Rhythm ST
belongings for
Breath Sounds clear
transfer to ICU.
Heart Sounds S1 S2
Abdominal Sounds
3. Delegates to
active in 4 quads
other RNs as
needed
Other Symptoms:
Confusion increased
(disoriented to place and 4. Call receiving
time), pain and lethargy RN in ICU and
continues
gives report using
SBAR
Verbalization
Where am I? What is
happening?
Alternate or Incorrect Treatment choice:
does not prepare for transfer or call report
Timing Sequence
Expected
5 min
Interventions
Baseline Vital Signs
Does not prepare
STATE 3C
for transfer and call
T PR 36.5, 115, 24
report
BP 90/60
SPO2 91%
After 5 min:
Cardiac Rhythm ST
RN preceptor
Breath Sounds clear
checks in to offer
Heart Sounds S1 S2
help with transfer
Abdominal Sounds
active in 4 quads
Other Symptoms:
Confusion increased
(disoriented to place
and time), pain and
lethargy continues
Verbalization
Where am I? What is
happening? Feels
afraid and anxious
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
15
SIMULATION DESIGN & PLANNING TEMPLATE
Correct Treatment Choice: provides
reassurance and communicates plan to pt, calls
daughter and informs her of changes in
condition and of plan
Timing Sequence
Expected
5 min
Interventions
1. Explains
Baseline Vital Signs
No Change
changes in
STATE 3 continues
condition to pt,
T PR 36.5, 115, 24
BP 90/60
2. tells pt that
SPO2 91%
s/he has called for
Cardiac Rhythm ST
extra help from
Breath Sounds clear
RRT and that she
Heart Sounds S1 S2
will be transferred
Abdominal Sounds
to ICU
active in 4 quads
Other Symptoms:
3. Calls daughter
Continued
to explain
disorientation
changes in
condition and
Verbalization:
Where am I? What is
plan
happening? Where is
my daughter? What are
you doing?
Alternate or Incorrect Treatment choice:
Does not provide reassurance or inform pt of
plan
Timing Sequence
Expected
5 min
Interventions
Does not explain
Baseline Vital Signs
No Change
changes in
STATE 3D
condition to pt and
T PR 36.5, 115, 24
inform her of plan
BP 90/60
SPO2 91%
After 5 min:
Cardiac Rhythm ST
RN preceptor
Breath Sounds clear
comes in and asks
Heart Sounds S1 S2
how pt is doing
Abdominal Sounds
active in 4 quads
Other Symptoms:
Increased agitation
Verbalization:
What is wrong? What is
happening? Why isn’t
my knee getting better?
Why won’t someone
help me? Where am I?
Alternate or Incorrect Treatment choice:
Does not call daughter
Timing Sequence
Expected
5 min
Interventions
Does not call
Baseline Vital Signs
No Change
daughter to explain
STATE 3E
changes in her
Other Symptoms:
mother’s condition
Increased agitation
and inform her of
plan
Verbalization:
What is wrong? What is
happening? Why isn’t
After 5 min:
my knee getting better? RN preceptor
Why won’t someone
comes in and asks
help me? Where am I?
how pt is doing
Where is my daughter?
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
16
SIMULATION DESIGN & PLANNING TEMPLATE
Instructor Check List
(return to CHESC assistant at the end of class)
Pre-Scenario Check List
1.
2.
3.
4.
5.
6.
7.
8.
Equipment is staged as requested.
The learner has been oriented to the simulator.
The learner understands the guidelines/expectations for the
scenario.
Participants understand their assigned roles.
The time frame Expectations for simulation met: Yes No.
The time frame Expectations for debrief met: Yes No.
Audio/Visual Consent signed and turned into CHESC sheet.
Attendance sheet completed and given to CHESC staff.
Post Scenario
If you could change anything next time, what would it be?
Comments:
________________________________________________________
________________________________________________________
________________________________________________________
CHESC Assistant Name:
Did the person provide excellent support for the scenario?
Yes
No Comment
Instructor signature ________________________________
Date
________________________
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
17
SIMULATION DESIGN & PLANNING TEMPLATE
Participant Check List
(return to Instructor at the end of class)
Pre-Scenario Check List
1.
2.
3.
4.
5.
I have been oriented to the simulator.
I understand the guidelines/expectations for the scenario.
I understand the assigned role.
My questions about the simulation have been answered.
I have all necessary equipment for the simulation.
Post Scenario
If you could change anything next time, what would it be?
Comments:
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Participant Signature ____________________________________
Date
________________________
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
18
SIMULATION DESIGN & PLANNING TEMPLATE
Simulation Post-Assessment Methods
Checklist
Tests
Evaluations
Turning Point
Jeopardy
Other
Optional Literature References
Debriefing Guidelines
(Remember to identify important concepts or curricular threads that are specific to your
program)
1. Leave the simulation room and go to a conference room, if possible. It allows for deescalation of emotions.
2. Solicit and validate emotions briefly. Validate simisms (the simulation isn’t 100% accurate
due to different equipment, personnel etc)
3. What went WELL in this simulation?
4. What DID NOT go well in this simulation?
5. If you could do it again, what would you do differently?
6. Summarize:
“What I hear you saying is . . .”
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
19
SIMULATION DESIGN & PLANNING TEMPLATE
References
Burdette, S. (2012, April 12). Systemic Inflammatory Response Syndrome. Medscape reference.
http://emedicine.medscape.com/article/168943-overview
Dellinger, R., Levy, M., & Rhodes, A. (2013). Surviving Sepsis Campaign: International guidelines for
management of severe sepsis and septic shock: 2012. Critical Care Medicine, 41(2), 580-637.
Gould, D. (2012). Causes, prevention and management of surgical site infection. Nursing Standard,
26(47), 47-56.
Joshi, M. (2011, February 19). Knee replacement surgeries take more time to conduct in overweight
patients . TopNews.in. www.topnews.in/health/knee-replacement-surgeries-take-more-time-conductoverweight-patients-210900http://
Kleinpell, R., Aitken, A., & Schorr, C. (2013). Implications of the new international sepsis guidelines
for nursing care. American Journal of Critical care, 22, 212-22.
Lobley, S. (2013). Factors affecting the risk of surgical site infection and methods of reducing it.
Journal of perioperative practice, 23(4), 77-81.
Reynolds, V. (2013). Assessing and diagnosing wound infection (part one). Nurse Prescribing, 11(3),
114-121.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
20
SIMULATION DESIGN & PLANNING TEMPLATE
Sepsis Admission orders
Rose Henderson
Admit to ________________________ (medical surgical unit)
Diagnosis: s/p left total knee wound infection
Condition: Stable
Allergies: None
Code Status: Full Code
VS: Every 4 hours
Diet: 4gm sodium, Low cholesterol
Activity: Up with assist, using crutches, PT consult
IV: 0.9% Normal Saline @100 mL/hr
Medications:
Lisinopril 20 mg PO daily
Docusate sodium 100 mg twice daily
Ceftriaxone 2 grams IV daily
Oxycodone 5 mg/ APAP 325 mg 1-2 tablets PO every 6 hours prn pain
Acetaminophen 325 mg 1-2 tablets PO every 4 hours prn pain
Wound Care:
Measure left knee circumference daily
Cleanse knee wound with NS twice daily
Labs: CBC with differential and electrolyte panel in am
Intake and Output every shift
Notify physician:
Systolic BP less than 90 mmHg
Oxygen saturation less than 92%
Drainage from wound
Temperature greater than 38.5oC
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
21
SIMULATION DESIGN & PLANNING TEMPLATE
Signed:
Michael Johnson MD
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
22
SIMULATION DESIGN & PLANNING TEMPLATE
Medical History Chart
Date
Procedures/Treatments
Left total Knee Replacement
Hx hypertension
Date
Medicines Prescriptions
/Pr
Lisinopril 20 mg PO daily
Docusate Sodium 100 mg PO 2x/day
Oxycodone 5 mg APAP 325 1-2 tablets PO prn every 6 hours
Acetaminophen 325 mg 1-2 tablets prn every 4 hours
Date
Allergic reactions
NONE
Date
Q1.Questions/ Concerns
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
23
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