Rural SimCenter Scenario Template
Scenario Name:
Learner Preparation Exercise:
Review: (Insert skills or reading students should review)
High Fidelity
Low Fidelity
Static Model
Target Group:
Student
Professional
Level:
Advanced
Intermediate
Beginner
Learning Objectives:





Primary Objectives:
1.
2.
3.
4.
5.
Insert Scenario Summary (Basic overview of Case)
Secondary Objectives:
1.
2.
3.
4.
5.
Total Time Duration:
Set-up
Preparation
Simulation
Debrief
Revised 7/14
1
Rural SimCenter Scenario Template
Initial Subjective Data:
Background Information:
Past History:
.
Presenting History:
Patient Description and Image
Name
Age
Birthdate
Gender
Weight
Height
Allergies
Select “insert picture”
image-- then right click.
Click on change picture
and choose your image.
Then delete this text box
or insert details.
Revised 7/14
2
Scenario: Insert Condition-Patient Name-Birthday
Supplies
IV Set Up
Saline Lock
Set-up Notes:
What is needed for the patient (simulator/actor) and
what is needed for the patient room?
Setting:
IV
IV Pump
Second IV
Fluid Type:
ICU
Emergency
Infusion Rate:
Out-Patient
Medical
Surgery/OR
Other ________________________
Tubing:
Medications
Med Dispense
Monitor Setup:
Primary ECG
Respiratory Rate
Secondary ECG
B/P
SPO2
Pulse
Temp
CO2
Medication List
1.
2.
3.
4.
5.
6.
7.
Other Settings
Moulage:
Patient Actors Requested:




Age
Gender
Clothing
Relationship to Patient
Revised 7/14
3
Scenario: Insert Condition-Patient Name-Birthday
Equipment:
Nasal Cannula
Paperwork*
O2 Mask
PPE (goggles, gloves, etc)
EMR
Suction
Thermometer
Chest Tube
Non-Rebreather
Penlight
Crash Cart
Accucheck
NG Tube
Physician Orders
Chart
Lab Reports
*Attach Reports to the file
Other
Please Describe Additional Equipment Needs
Facilitator Notes:
Revised 7/14
4
Scenario: Insert Condition-Patient Name-Birthday
Scenario Progression: Admission Information
Initial State: Frame 1
Initial Patient History
Vital Signs
Body System Assessment
Cardiac Rhythm:
 Neurological/Sensory
Pulse:
 Cardiac
Respiratory Rate:
 Pulmonary
Breathing Pattern
 Musculoskeletal
Chest Rise
 Gastrointestinal
Blood Pressure:
 Genitourinary
SPO2
 Skin/Wound
General Conditions to be in place for Scenario:
 Vocal Complaint
Correct Action
Move to Frame:
 Initial Lab/Diagnostics
Wrong Action
Move to Frame:
No Action
Move to Frame:
Patient Finding
Facilitator Notes:
Revised 7/14
5
Scenario: Insert Condition-Patient Name-Birthday
Initial State: Frame 2
Change in Patient Condition
Vital Signs
Body System Assessment
Cardiac Rhythm:
 Neurological/Sensory
Pulse:
 Cardiac
Respiratory Rate:
 Pulmonary
Breathing Pattern
 Musculoskeletal
Chest Rise
 Gastrointestinal
Blood Pressure:
 Genitourinary
SPO2
 Skin/Wound
General Conditions to be in place for Scenario:
 Vocal Complaint
Correct Action
Move to Frame:
 New Lab Reports
Wrong Action
Move to Frame:
No Action
Move to Frame:
Patient Finding
Facilitator Notes:
Revised 7/14
6
Scenario: Insert Condition-Patient Name-Birthday
Initial State: Frame 3
Initial Patient History
Vital Signs
Body System Assessment
Cardiac Rhythm:
 Neurological/Sensory
Pulse:
 Cardiac
Respiratory Rate:
 Pulmonary
Breathing Pattern
 Musculoskeletal
Chest Rise
 Gastrointestinal
Blood Pressure:
 Genitourinary
SPO2
 Skin/Wound
General Conditions to be in place for Scenario:
 Vocal Complaint
Correct Action
Move to Frame:
 Initial Lab/Diagnostics
Wrong Action
Move to Frame:
No Action
Move to Frame:
Patient Finding
Facilitator Notes:
Revised 7/14
7
Scenario: Insert Condition-Patient Name-Birthday
Initial State: Frame 4
Change in Patient Condition
Vital Signs
Body System Assessment
Cardiac Rhythm:
 Neurological/Sensory
Pulse:
 Cardiac
Respiratory Rate:
 Pulmonary
Breathing Pattern
 Musculoskeletal
Chest Rise
 Gastrointestinal
Blood Pressure:
 Genitourinary
SPO2
 Skin/Wound
General Conditions to be in place for Scenario:
 Vocal Complaint
Correct Action
Move to Frame:
 New Lab Reports
Wrong Action
Move to Frame:
No Action
Move to Frame:
Patient Finding
Facilitator Notes:
Revised 7/14
8
Scenario: Insert Condition-Patient Name-Birthday
Initial State: Frame 5
Change in Patient Condition
Vital Signs
Body System
Assessment
Cardiac Rhythm:
Patient Finding
 Neurological/Sensory
Pulse:
 Cardiac
Respiratory Rate:
Breathing Pattern
 Pulmonary
Chest Rise
 Musculoskeletal
Blood Pressure:
 Gastrointestinal
SPO2
 Genitourinary
General Conditions to be in place for Scenario:
 Skin/Wound
 Vocal Complaint
Correct Action
Move to Frame:
Wrong Action
Move to Frame:
No Action
Move to Frame:
 New Lab Reports
Facilitator Notes:
Revised 7/14
9
Scenario: Insert Condition-Patient Name-Birthday
Initial State: Frame 6
Change in Patient Condition
Vital Signs
Body System Assessment
Cardiac Rhythm:
 Neurological/Sensory
Pulse:
 Cardiac
Respiratory Rate:
 Pulmonary
Breathing Pattern
 Musculoskeletal
Chest Rise
 Gastrointestinal
Blood Pressure:
 Genitourinary
SPO2
 Skin/Wound
General Conditions to be in place for Scenario:
 Vocal Complaint
Correct Action
Move to Frame:
 New Lab Reports
Wrong Action
Move to Frame:
No Action
Move to Frame:
Patient Finding
Facilitator Notes:
Revised 7/14
10
Scenario: Insert Condition-Patient Name-Birthday
Scenario Progression Algorithm: Copy and use images to create your algorithm
FRAME:
Rhythm:
Resp:
SPO2:
B/P
Vocal Cue:
Rate:
B/P:
Temp
FRAME:
Rhythm:
Resp:
SPO2:
B/P
Vocal Cue:
Rate:
B/P:
Temp
FRAME:
Rhythm:
Resp:
SPO2:
B/P
Vocal Cue:
Rate:
B/P:
Temp
FRAME:
Rhythm:
Resp:
SPO2:
B/P
Vocal Cue:
Rate:
B/P:
Temp
FRAME:
Rhythm:
Resp:
SPO2:
B/P
Vocal Cue:
Revised 7/14
Rate:
B/P:
Temp
FRAME:
Rhythm:
Resp:
SPO2:
B/P
Vocal Cue:
Rate:
B/P:
Temp
11
Scenario: Insert Condition-Patient Name-Birthday
FRAME:
Rhythm:
Resp:
SPO2:
B/P
Vocal Cue:
FRAME:
Rate:
B/P:
Temp
Rhythm:
Resp:
SPO2:
B/P
Vocal Cue:
Rate:
B/P:
Temp
Revised 7/14
12
Scenario: Insert Condition-Patient Name-Birthday
RURAL SIMCENTER
MEDICATION ADMINISTRATION RECORD
NAME:
DOB:
GENDER:
PT. ID #
ALLERGIES:
Medication Order
Revised 7/14
ROOM #
PHYSICIAN:
PATIENT NOTES & COMMENTS:
Scheduled Time
Time Administered
Nurse Initials
Comments
RURAL SIMCENTER
PHYSICIAN’S ORDERS
NAME:
ROOM NO:
PATIENT ID NO
PHYSICIAN:
Drug Allergies
Another brand of drug identical in form
and content may be dispensed unless checked
Nurse’s
Initials
1.
2.
3.
5.
6.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Doctor Sign
PHYSICIAN’S ORDERS
Revised 7/14
RURAL SIMCENTER
PATIENT CHART
Name:
GENDER:
DOB:
PATIENT ID:
Case Details:
Shift Report:
Revised 7/14
ALLERGIES:
PRIMARY PHYSICIAN:
RURAL SIMCENTER
Patient Actors Roles:
Suggested Dialogue for each Actor
Key Points to emphasize:
Suggested Character Development:
Revised 7/14
RURAL SIMCENTER
DEBRIEFING
Points
Instructors should developed a structured debriefing and develop questions related to:
1.
2.
Objectives
Teamwork
a. Who was the leader?
b. What were the roles
c. Distribute workload
d. Did the team have a shared mental model?
e. Mutual Performance Monitoring?
f. Communicate often enough?
3.
CRM Principles: How did the team do?
a. Communicate effectively—Establish a shared mental model
b. Anticipate and plan
c. Call for Help early
d. Use all available resources
e. Use resources wisely—People and equipment
f. Avoid fixation errors
g. Use good leadership
h. Be a good follower
i. Mutual Respect
j. Adjust strategies under stress
k. Avoid and manage conflict
4.
5.
6.
7.
Patient Safety
Patient Teaching
Systems Errors
Scope of Practice
Tips for Debriefing
1.
2.
3.
4.
Learner focused
Allow enough time for learning (2-3 times the scenario length)
Focus on the process not the individual
Keep the debriefing positive
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