Simulation Design Template
Acute Stroke - Simulation Design Template – Loyalist College
Program: Nursing Course: NURS 2005
Review date:
Original Author/year: Tammy Armstrong(O’Rourke)/2007,Reviewed 2009, Julie Rivers revision 2014
_X_Formative assessment ___Summative assessment or ___OSCE /High stakes assessment
Prep/Pre-meeting Time: 0
Expected Simulation Run Time: 15 min
Debrief/Guided Reflection Time: 15 min
Alternate Activity Location Required: No
Simulation Learning Objectives (Identify related Course Learning Outcome and Program Terminal
Outcome by number only)
The Student group will:
1. Demonstrate understanding of assessment of a person experiencing CVA.(CLO 1,2,3 , PLO 1,2,3)
a. Carry out a focused neurological assessment of a patient who has a stroke using the Canadian
Neurological Scale Tool
b. Assess vital signs and patient’s symptoms/concerns
c. Carry out appropriate interventions in response to assessment findings
d. Identify assessment findings which could lead to complications
2.
Identify and consult appropriate resources while assessing, planning (including prior to lab), and
implementing care. (CLO 1,2,3,6 PLO 1,2,3,6)
3. Respond appropriately to family member question(s) (CLO 1, 2, 3, 6 PLO 1, 2, 3, 6)
4. Participate in creating SBAR report at the end of the simulation (CLO 3, PLO 3)
Measurement of Objectives
1. During scenario, identified by handler events in debrief document for a-c.
During debrief discussion for d.
2. During scenario, identified by handler events in debrief document and discussed in debriefing session
3. During scenario identified by professor and discussed during debrief.
4. Written and verbal (time permitting) report at end of simulation.
Skills/Theory required prior to participation in simulation
o See Course Documentation for prerequisites and co-requisites
o Cardiovascular, neurological assessment and stroke (including use of CNS tool) lecture content of
NURS 2004
o Familiarization with use of blood glucose meter
Simulation Design Template
Student Preparation for Simulation
Review and research pertinent patient information package provided - see Appendix A
Student preparation package to be distributed: See Appendix A Prior to Simulation - included in Blackboard
course materials
References, Evidence-Based Practice Guidelines, Protocols, or Algorithms used for this scenario: (site
source, author, year, and page)
Canadian Pharmacists Association. (2013). e-CPS. Ottawa, Ontario, Canada.
Health Quality Ontario & Ministry of Health and Long-Term Care. (2013, September). Quality-Based
Procedures Clinical Handbook for Stroke. Retrieved from Ontario Ministry of Health and Long-Term
Care: http://health.gov.on.ca/en/pro/programs/ecfa/docs/qbp_stroke.pdf
Jarvis, C. (2009). Physical examination & Health Assessment (1st Canadian ed.). Toronto: Saunders Elsevier.
Lewis, S. H. (2010). Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems
(2nd Canadian ed.). Toronto: Elsevier Canada.
Lewis, S., Ruff Dirksen, S., Howard, V., Heitkemper, M., Schumacher, L., Weberg, D., and Bucher, L. (2011).
Simulation Learning System for Lewis et al: Medical Surgical Nursing. (8th ed). Retrieved from
https://evolve.elsevier.com/Courses/14402_jrivers12_1001
The Canadian Stroke Strategy. (2014). Retrieved from Canadian Best Practice Recommendations for Stroke
Care: http://www.strokebestpractices.ca/index.php/about-us/
The Canadian Stroke Strategy. (2014) Retrieved from Canadian Best Practice Recommendations for Stroke
Care: Hyperacute Stroke Care recommendations: http://www.strokebestpractices.ca/wpcontent/uploads/2010/10/Ch3_SBP2013_Hyper-Acute-_23MAY13_EN_-FINAL5.pdf


pathophysiology notes re CVA
BPG’s - RNAO Stroke Assessment across the continuum of Care 2011 Supplement found at url
http://rnao.ca/sites/rnao-ca/files/storage/related/7708_STROKE_Supplement_FA.PDF
Optional Stroke Nurse Pocket guide provided by professor, need to order from Heart and Stroke
Lewis, S., Ruff Dirksen, S., Howard, V., Heitkemper, M., Schumacher, L., Weberg, D., and Bucher, L. (2011).
Simulation Learning System for Lewis et al: Medical Surgical Nursing. (8th ed). Retrieved from
https://evolve.elsevier.com/Courses/14402_jrivers12_1001. Simulation 20 Naomi Reed.
External Expert Review
2006, original co-author, Stroke Unit co-ordinator, Sue Kotel
December 2013, Melissa Roblin, RN, BScN - Stroke clinical resource Nurse Quinte Healthcare Corporation and
Michelle Slapkauskas, RN, BScN, Stroke prevention clinic nurse, Quinte Healthcare Corporation
Simulation Design Template
Brief Description of Patient:
Name: Mr(s). Sidney Smith
Gender: M or F
Race: Caucasian
Weight: 92kg
Height: 175cm
Religion:
Major Support: spouse and children
Allergies: ASA & Penicillin
Bdate: 08/05/39
Phone:
Immunizations: UTD
Attending Physician/Team: Stroke team
Primary Diagnosis: Right MCA stroke
Surgeries/Procedures:
History of Present Illness: awoke with symptoms and is thus not eligible for tPA
Past Medical History: long-standing hypertension, acute MI 2years ago, CABG X 3 shortly thereafter.
Social History: smokes 1 pack of cigarettes per day
Fidelity
Setting/Environment
o Med-Surg
Simulator Manikin/s Needed:
Patient actor or Sim Man
Equipment attached to Patient actor or
Sim man:
o
o
o
o
o
ID band _ Mr(s). Sidney Smith
Allergy band- ASA, Penicillin
IV- N/S @75ml/hr
Telemetry monitor
Glucose bubbles to Sim Man fingers,
or manikin hand for pt actor
o Injectapad on abdomen
Equipment available in room
o Stethoscopes
o Glucometer
o Med Cart
o Supply cart
o Pen light
o Computer for Edoc
Medications and Fluids
o IV Fluids:
Normal Saline
o Oral Meds:
Ramipril 5mg po daily
ASA 81 mg po daily
Atorvastatin 20 mg po daily
Nicorette gum 2 mg
Nicoderm 21 mg patch
Acetaminophen 650mg PO/PR q4h prn for
temperature > 37.5 or pain
o IM or SC:
Regular Insulin Sliding Scale q4h
Diagnostics Available
o Glucometer q4h
Documentation Forms
o ER History and Physical
o ER neuro assessment record
o ECG
o Head CT results
o Lab results
o Acute Ischemic Stroke Order set
o Sliding scale insulin order set
Simulation Design Template
o Canadian Neurological Scale
Observation Record and Canadian
Neurological Scale Reference Sheet
o Edoc
Recommended Mode for Simulation:
4 students with roles as assigned
Students to work independently from
faculty
Student Information Needed Prior to
Roles / Guidelines for Roles
Scenario:
o Primary Nurse
Prebrief:
o Secondary Nurse
As with all scenarios:
o Family member
Speak out loud your observations and
o Documenter/resource
assessments and discuss with your partner
as appropriate
Treat the actor/simulator as a real patient
Description of Roles
Primary nurse: Assess patient, follow stroke Carry over all safety, infection control and
order set and carry out interventions as
communication skills you have previously
appropriate. Complete SBAR at end of
learned
simulation to report off duty.
Call for assistance as needed
Secondary nurse: Assist primary nurse as
With this simulation the vitals will appear
appropriate and assist with SBAR report.
on the monitor and stay there for future
Family member: Interact in simulation
reference. If you are rechecking a vital,
according to script and briefing.
please say it out loud so that your partner
Documenter/resource: Document vitals and knows you have checked it and what the
stroke assessment in Edoc. Provide cueing
value is. The CNS tool and neuro
assistance to primary and secondary nurse as
assessment is on Edoc for the
appropriate and assist with SBAR report
documenter/resource to refer to and
complete. State your findings for the CNS
assessment out loud so that your
documenter can enter this on eDoc as you
are completing it.
Critical Lab Values:
Chemistry
Glucose: 11.3 (H)– normal 3.5-10.0
Report students will receive before
BUN: 4.6 - normal 3.5-7.5mmol/L
simulation:
Creatinine: 67- normal 50-120mmol/L
S. I have just brought Sidney Smith up
Sodium: 137- normal 135-145
from ER. He/she is being admitted to your
Potassium: 4.4- normal 3.6-5.2mmol/L
unit with a Dx of Rt MCA stroke.
Chloride: 99- normal 99-108mmol/L
Hemoglobin 160 –normal 135-175
Hematocrit 0.48 – normal 0.40-0.50
WBC 6.8 – normal 4.0-11.0
B. He/She has been in emerg for 12 hours.
His/her Hx is an acute MI 2 yrs ago and
CABG x 3 soon after. (S)He has a longstanding Hx of hypertension and is a pack
a day smoker. Sidney awoke with Sx of
Simulation Design Template
stroke and was ineligible for tPA. He/She
Urinalysis
Urine Colour: Yellow
is 70 years old. Sidney is allergic to ASA
Appearance: Clear
and penicillin. We have put him/her on
Specific Gravity:1.025 – normal 1.003-1.030 telemetry and put a lock in and started N/S
Glucose: negative
@ 75 cc/hr. CNS score in ER was 5.5
Ketones: negative
Blood: negative
A. Last time I checked him/her vitals were
pH: 5.5 (normal 5.0-8.0)
OK, BP still elevated and sats low normal.
Protein: negative
We have been busy, so just time enough to
Nitrites: negative
start the IV since he/she got back from CT
scan.
Other
LKCS: 9.6- normal 4.0-11.0
R. Sidney is on the standard stroke orders,
ERCS: 3.75(L)- normal
and I think you have those already.
Physician Orders:
Acute Ischemic Stroke Orders filled out and
on chart
Scenario Progression Outline
Timing
(approximate)
Time of Day for
simulation is:
Noon
First Phase
Assessment
Patient Actions
Expected Interventions
Patient actor/SimMan’s initial condition:
Hand Hygiene
Introduce self, explains what
she/he is about to do
Vitals on monitor
T- 37.2
P- 86
R- 22
BP- 185/90
O2 sat- 94%Pupils are equal
bilaterally and react to
light
LOC is alert to a bit
drowsy
Assess vital signs
TPR, BP, O2 sat
Assess pupil size and reaction to
light
Assess Level of Consciousness
CNS assessment
Orientation
Location, month, year
May use the
following Cues:
Family member
has script see
Appendix B and
will interact in
simulation as
per script and
pre-brief
instructions
Simulation Design Template
CNS responses
Receptive speech
Orientation normal for
Close eyes
place and
Stone sink in water
time(month,year)
Point to ceiling
Receptive speech normal
to close eyes answer yes
to does a stone sink in
water and point to ceiling
with Right hand.
Expressive speech
normal - can name 3
items and identify their
use
Motor function - Left
facial droop. Left side
unable to move except if
asked to squeeze then
very weak in left and can
wiggle left toes
Expressive speech
Identify 3 items and purpose
Motor function
Face, proximal arm, distal arm,
proximal leg, distal leg
Motor response to resistance
arms, legs
CNS score should be 5.5
Student should identify deficits
and may ask documenter how
CNS score relates to previous
CNS score
If asked how body feels
respond
My entire left side –
face, arm and leg feel
kind of numb and heavy
Second Phase
Medication
administration
and
Blood Glucose
T-37.2 P-86 R-22 BP
185/100
Sats 93%
Blood glucose 11.0
Recognize BP elevated and
check orders or knows no prn
treatment required according to
BPG/orders
Check blood glucose with
glucometer
Respond to patient question
regarding blood glucose testing
as body’s reaction to stress and
pt is not diagnosed as diabetic
Check orders or ask resource
nurse what treatment
parameters and if med needed
Role member
providing cue:
Pt
Actor/SimMan
Cue: Why have
they been
checking my
sugar, nurse? I’m
not diabetic.
Simulation Design Template
Administer Insulin as ordered
Third Phase
Reporting of
pertinent
information
Gives written report in SBAR
format to faculty member acting
as nurse coming on duty to
relieve team
SBAR should include: See
Appendix C - CNS score and
specific noted limitations VS
including blood glucose, motor
function/strength and sensation
AND any interventions performed
or complications to be monitoring
for.
Debriefing / Guided Reflection for this Simulation:
1. What elements of the RNAO BPG Stroke assessment across the continuum of care were you able to
implement during the simulation?
2. Were you able to use the CNS tool to assess this patient? What did the results indicate to you?
3. What assessment findings were abnormal for this person, would you act on them and what would your
actions be
4. Did you note any potential complication(s) of stroke with your assessment findings? If so what were the
findings and potential complication(s). If not what might some be?
5. Can you identify members of the collaborative team for this patient and when their involvement would
start and end? During sim and beyond day 2 after a stroke.
6. Tell me about your experience with preparing an SBAR report for this situation.
7.
Optional Activity
Have the group remain after simulation and complete a concept map using SLS format for Naomi Reed case
study
Simulation Evaluation Process
For Faculty - See Appendix E
For Students - See Appendix F
Simulation Design Template
Appendix A
Student preparation package for
ACUTE STROKE SIMULATION
LEARNING OBJECTIVES
The Student group will:
1. Demonstrate understanding of assessment of a person experiencing CVA
a. Carry out a focused neurological assessment of a patient who has a stroke using the Canadian
Neurological Scale Tool
b. Assess vital signs and patient’s symptoms/concerns
c. Carry out appropriate interventions in response to assessment findings
d. Identify assessment findings which could lead to complications
2.
Identify and consult appropriate resources while assessing, planning (including prior to lab), and
implementing care.
3. Respond appropriately to family member question(s)
4. Participate in creating SBAR report at the end of the simulation
TOOLS FOR PRACTICE
Lab coat, notes for documenter/resource, Stroke nurse pocket guide, RNAO BPG Acute Stroke
Lab set up, equipment and medical supplies for simulation, Edoc, SBAR tool
STUDENT PREPARATION FOR SIMULATION:








Lewis et al. Chapter 59
Jarvis Chapter 23 review with specific focus on Stroke assessment and check Index
Pathophysiology Notes: Cerebrovascular Accident
Stroke Assessment Across the Continuum of Care: Summary of BPG Recommendations 2005 and
Supplement 2011 available at: http://rnao.ca/bpg/guidelines/stroke-assessment-across-continuum-care
The Canadian Stroke Strategy. (2014) Retrieved from Canadian Best Practice Recommendations for
Stroke Care: Hyperacute Stroke Care recommendations: http://www.strokebestpractices.ca/wpcontent/uploads/2010/10/Ch3_SBP2013_Hyper-Acute-_23MAY13_EN_-FINAL5.pdf
Stroke Nurse Pocket Guide, Heart and Stroke Foundation *Attention CNS tool (provided by professor)
Review and research pertinent data related to brief description and Doctor’s orders of patient provided
SLS for Lewis Medical Surgical Nursing navigate to Content home > Acute Stroke Simulation
Preparation > simulation 20 Naomi Reed and complete pre-simulation quiz and review SBAR report and
make notes to help you prepare to produce SBAR report in the simulation experience
Simulation Design Template
Brief Description of Patient:
Name: Sidney Smith
Gender: F
DOB: 08/05/1939
Race: Caucasian
Weight: 92kg
Height: 175cm
Religion: Catholic
Major Support: daughter/son
Allergies: ASA & Penicillin
Immunizations: UTD
Attending Physician/Team: Stroke team
Primary Diagnosis: Right Hemisphere mid cerebral CVA
History of Present Illness: awoke with symptoms and is thus not eligible for TPA
Past Medical History: long-standing hypertension, acute MI 2years ago, CABG X 3 shortly thereafter.
Social History: smokes 1 pack of cigarettes per day
Lab Tests and Values
Chemistry
Serum Glucose: 11.3 mmol/L
BUN: 4.6 mmol/L
Creatinine: 67 mmol/L
Sodium: 137 mmol/L
Potassium: 4.4 mmol/L
Chloride: 99 mmol/L
Hemoglobin: 160 g/L
Hematocrit: 0.48
WBC: 6.8
Urinalysis
Urine colour: yellow
Appearance: clear
Specific Gravity: 1.025
Glucose: negative
Ketones: negative
Blood: negative
pH: 5.5
Protein: negative
Nitrites: negative
Other
LKCS: 9.6
ERCS: 3.75
Simulation Design Template
Stroke Standard Order set
ORDER AND SIGNATURE
Check box if order is to be followed and sign bottom of each page
Vital signs monitoring
X Vital signs and Canadian Neurological Scale (for alert or drowsy patients)
Q 1 h x 4, q 2h x8, q 4h then reassess
Vital signs and Glasgow Coma Scale (for stuporous patients)
Q ½h x 4 h, q 2-4 h x 24 h, q 4-6 h x 48 h, then reassess
Notify physician if:
Systolic BP greater than _220_mmHg, or less than _90_mmHg or
Diastolic BP greater than _120_mmHg, or less than _40_mmHg
*Guidelines suggest Antihypertensive therapy only if SBP>220 or DBP >120 of if stroke is accompanied by MI,
acute renal failure or aortic dissection.
Activity
Bedrest for 24 h, then AAT
X AAT Physio to assess
Nutrition
X NPO until swallowing assessment completed. If patient passes swallowing screen order diet indicated
below. If patient does not pass swallowing screen refer to speech language pathology
Regular
Dysphagia Modified texture
NPO
X No added salt (if hypertensive)
X Low cholesterol (if elevated)
Other diet: __________________
Head of bed elevated (high fowler’s or upright) during and 1 h pc meals
Weigh if possible
Oxygen Therapy
X O2 therapy orders: oxygen by nasal prongs @ 3L for SaO2 < 92
____________________________________________________
Physician signature:
K Koch
Printed name: K Koch
Date and time: 0100 day of simulation
Simulation Design Template
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Monitoring
Cardiac monitoring x 24 h
Portable chest x-ray
Intermittent catheterization prn for urinary retention
12 lead ECG
Intake and output
Investigations
CT Head
Echocardiogram
Carotid Doppler studies
Blood sugar by glucose meter q 4 h for 24 h, then QID for 2 days, then reassess
CBC, electrolytes, urea, creatinine, glucose, albumin, calcium, magnesium, CK, ALP, ALT, AST,
LDH, Total bilirubin, INR, PTT, total cholesterol, Cholesterol/HDL ration, triglycerides fasting
in am, Hb A1C
Other investigations: ________________________________________________
Intravenous therapy
IV 0.9% sodium chloride at _75_ ml/h while NPO
IV 0.9% sodium chloride at ____ ml/h with ____ mEq KCl/L (20 mEq/L or 40 mEq/L)
Iv saline lock, flush with 5 ml 0.9% sodium chloride BID and prn
Antipyretic therapy
Acetaminophen 650 mg PO/PR q4h prn for temperature >37.5 or pain
Antiplatelet therapy
ASA 650 mg sup PR daily
ASA 325 mg PO daily
ASA 81 mg PO daily
Clopidrogel 75 mg PO daily
ASA 25 mg/dipyridamole XR 200 mg (Aggrenox) 1 capsule PO bid
Secondary prevention medications
Atorvastatin _20_ mg PO daily
Ramipril _5_ mg PO daily start date:_after swallowing screen if negative
Nicotine replacement patch/gum: Nicorette gum 2mg, one piece of gum per hour as required
for nicotine cravings, if not effective then Nicoderm 21 mg patch, apply one patch q 24 h prn
for nicotine cravings
Physician signature:
K Koch
Printed name: K Koch
Date and time: 0100 day of simulation
Simulation Design Template
Consults
Internal medicine
X Physiotherapy
X Speech language pathology
Clinical nutrition
X Occupational therapy
Social work
Continuing stay coordinator
Physician signature:
K Koch
Printed name: K Koch
Date and time: 0100 day of simulation
Simulation Design Template
Simulation Design Template
Simulation Design Template
Role / Description
Nurse 1: Primary - assess patient, direct care and attend to patient, create an SBAR report at the end of the
simulation
Nurse 2: Secondary - assist primary nurse during simulation and with SBAR report.
**It would also be helpful for Primary and Secondary nurse to make point form notes or a plan of action prior
to lab and give to documenter/resource to use during simulation, and to have CNS in pocket for reference.
Remember to research medications on Physician’s orders as preparation.
Documenter/Resource: Review MAR prior to simulation by using documents in student preparation package.
You will have the Acute Stroke RNAO BPG guideline, Edoc and CNS Nurse Pocket Guide to refer to. The
resource person is to help the primary or secondary nurse with information and/or prompts during the
simulation. You will log in to Edoc, find this patient and document CNS assessment and vitals as the primary
and secondary nurse complete them. Assist with SBAR report at the end of the simulation.
Family member: Will have a script and will participate in simulation as directed by faculty or sim specialist
Simulation Design Template
Appendix B - Family member script
If asked if the patient responses are normal state yes.
As the nurses do the motor function testing ask what they are doing and why?
If the nurses take a blood sugar reading, ask what they are doing, why and if your relative is diabetic.
If activities are at a lull, ask if your relative will be able to walk again.
If activities are at a lull express concern about your relative’s ability to go home and how she will cope as you
live out of town.
Simulation Design Template
Appendix C - SBAR report expected at end of simulation
Situation
Background
Assessment
Recommendation
My name is……
I am giving report about ….pt name
Sidney presented at emerg for 13 hours ago.
Hx acute MI 2 yrs ago and CABG x 3 soon after. Sidney has a
long-standing Hx of hypertension and is a pack a day smoker.
Pt awoke with Sx of stroke and was ineligible for tPA. Sidney is
__ years old.
Pt is allergic to ASA and penicillin.
Pt is on telemetry and has an IV with N/S @ 75 cc/hr. CNS
score in ER was 5.5.
CT scan in emerg revealed Rt MCA stroke, BP was high and
sats low normal, otherwise vitals within normal limits.
vitals on last check at noon were T- 37.8 P- 86 R- 22 BP185/90, O2 sat- 94% on room air, vitals are q 4h now
Pt is on stroke protocol orders
IV 0.9% NaCl at 75 ml/hr, cardiac monitoring for another 11 hrs,
CNS score at noon was 5.5 There is no muscle movement in L
side and L facial droop. Language and orientation are normal
except slurred speech due to L facial droop
BG was -- and I gave….units of regular insulin at noon
We have kept pt NPO until speech therapist assesses, so PO
meds have been held until now. Activity level is AAT
I did not give ASA as Sidney is allergic either I called Dr or in R
will you call Dr.
Could you assume her care and see when Speech therapist is
due to visit and call the Dr about the po meds as I have not had
a chance to do yet.
Simulation Design Template
HSL HEALTH CARE
MEDICATION ADMINISTRATION RECORD
Pat:
ID #:
AGE:
ADMITTED:
ALLERGIES:
Sidney Smith
806372
Dx:
74
BIRTHDATE:
08/05/1939 SEX:
PHYSICIAN: KK
ASA, Penicillin
1 - Pt. REFUSED
6 - Pt. OUT ON PASS
2 - Pt. NPO
7 - HR < 60
MEDICATION
MAR START DATE:
Acute Stroke
F
WT:
LOCATION:
MAR START TIME:
CHARTING LEGEND
3 - HOLD
4 - NAUSEA/VOMITTING
8 - Pt. SLEEPING
9 - SELF MED PROGRAM
****** STAT & NON - RECURRING ORDERS ******
DOSE
ROUTE
DATE
5 - IV SITE OUT
10 - ALTERNATE ROUTE GIVEN
TIME
INITIALS
0730 - 1529
1530 - 2359
******SCHEDULED MEDS******
Rx#
DRUG:
DOSE:
MEDICATION
ASA
81 mg
ROUTE:
PR
0000 - 0729
0800__3 JR
SIG: 0800
DIRECTIONS: OD
ORD DR:
KK
CP
TRANSCRIBED BY:
START:
STOP:
CHECKED BY: JR
DATE/TIME:
0000 - 0729
DRUG:
DOSE:
Ramipril
5 mg
ROUTE:
PO
0730 - 1529
1530 - 2359
0800__2 JR
SIG: 0800
DIRECTIONS: OD
ORD DR:
KK
TRANSCRIBED BY:
CP
START:
CHECKED BY: JR
STOP:
DATE/TIME:
0000 - 0729
DRUG:
Insulin Regular-Sliding Scale
DOSE:
4.1 - 5
0 units
ROUTE:
5.1 - 8
0 units
SIG: Q 4 H
Subcutaneous 8.1 -10 2 units
DOSE:
ROUTE:
20mg
PO
GM________
Dose 2 units
Dose________
Dose_______
START:
CHECKED BY:
JR
Dose________
STOP:
DATE/TIME:
0000 - 0729
Atorvastatin
GM 9.1
GM_________ GM________
12.1-15 6 units
DRUG:
1530 - 2359
1700____/_____
1200___/_____ 2100____/_____
10.1-12 4 units
15.1-22 8 units
TRANSCRIBED BY:
CP
0730 - 1529
0800 JR/PM
SIG: 0800
0730 - 1529
1530 - 2359
0800 2 JR
DIRECTIONS: OD
ORD DR:
KK
TRANSCRIBED BY:
CP
START:
CHECKED BY:
JR
STOP:
DATE/TIME:
0000 - 0729
DRUG:
DOSE:
ROUTE:
DIRECTIONS:
ORD DR:
TRANSCRIBED BY:
SIG:
START:
CHECKED BY:
STOP:
DATE/TIME:
0730 - 1529
1530 - 2359
Simulation Design Template
HSL HEALTH CARE
MEDICATION ADMINISTRATION RECORD
PAT:
ID#:
AGE:
ADMITTED:
ALLERGIES:
Sidney Smith
806372
DX:
74
BIRTHDATE: 08/05/1939 SEX:
PHYSICIAN: KK
NKA
1 - Pt. REFUSED
6 - Pt. OUT ON PASS
Rx#
IV SOLUTION
RATE
MAR START DATE:
Acute Stroke
F
WT:
LOCATION:
CHARTING LEGEND
3 - HOLD
8 - Pt. SLEEPING
2 - Pt. NPO
7 - HR < 60
4 - NAUSEA/VOMITTING 5 - IV SITE OUT
9 - SELF MED PROGRAM 10 - ALTERNATE ROUTE GIVEN
******CONTINUOUS INFUSIONS******
MEDICATION
0.9% NaCl
75 ml/hr
*while NPO
DATE
TIME
TRANSCRIBED BY:
CP
RATE
MAR START TIME:
0000 - 0729
0730 - 1529
1530 - 2359
0000 - 0729
0730 - 1529
1530 - 2359
0000 - 0729
0730 - 1529
1530 - 2359
RN/RPN
CHECKED BY:
BY: JR
DATE/TIME:
IV SOLUTION
RATE
DATE
TIME
TRANSCRIBED BY:
RATE
RN/RPN
CHECKED BY:
DATE/TIME:
IV SOLUTION
RATE
DATE
TRANSCRIBED BY:
TIME
RATE
RN/RPN
CHECKED BY:
DATE/TIME:
Simulation Design Template
HSL HEALTH CARE
MEDICATION ADMINISTRATION RECORD
Pat:
ID #:
AGE:
ADMITTED:
ALLERGIES:
Sidney Smith
806372
Dx:
74
BIRTHDATE:
08/05/1939 SEX:
PHYSICIAN: KK
ASA, Penicillin
1 - Pt. REFUSED
6 - Pt. OUT ON PASS
MAR START DATE:
Acute Stroke
F
WT:
LOCATION:
CHARTING LEGEND
3 - HOLD
8 - Pt. SLEEPING
2 - Pt. NPO
7 - HR < 60
MAR START TIME:
4 - NAUSEA/VOMITTING
9 - SELF MED PROGRAM
5 - IV SITE OUT
10 - ALTERNATE ROUTE GIVEN
******PRN MEDS******
Rx#
DRUG:
MEDICATION
Acetaminophen
DOSE:
650 mg
ROUTE:
PO or PR
0000 - 0729
0730 - 1529
1530 - 2359
0000 - 0729
0730 - 1529
1530 - 2359
0000 - 0729
0730 - 1529
1530 - 2359
0000 - 0729
0730 - 1529
1530 - 2359
0000 - 0729
0730 - 1529
1530 - 2359
SIG:
DIRECTIONS: Q 4 h PRN for temp> 37.5'C or for pain
ORD DR:
KK
TRANSCRIBED BY:
CP
START:
STOP:
CHECKED BY: JR
DATE/TIME:
DRUG:
DOSE:
ROUTE:
SIG:
DIRECTIONS:
ORD DR:
START:
STOP:
TRANSCRIBED BY:
CHECKED BY:
DATE/TIME:
DRUG:
DOSE:
ROUTE:
SIG:
DIRECTIONS:
ORD DR:
START:
STOP:
TRANSCRIBED BY:
CHECKED BY:
DATE/TIME:
DRUG:
DOSE:
ROUTE:
SIG:
DIRECTIONS:
ORD DR:
START:
STOP:
TRANSCRIBED BY:
CHECKED BY:
DATE/TIME:
DRUG:
DOSE:
ROUTE:
DIRECTIONS:
ORD DR:
TRANSCRIBED BY:
SIG:
START:
CHECKED BY:
STOP:
DATE/TIME:
Simulation Design Template
Appendix E
Faculty Evaluation for Acute Stroke Simulation
Please select from Likert scale the extent to which you felt this group of students met the learning
activity objectives.
1
2
3
< 50% met with
100% met
< 50% met with
Critical elements
non critical elements
missed
4
> 50% met
5
>75% met
90-
missed
1. Carry out a focused neurological assessment of a patient who has a stroke using elements of the
RNAO BPG “ Stoke Assessment Across the Continuum of Care” and the Canadian Neurological Scale
1
2
3
4
5
2. Identify assessment findings which could lead to complications
1
2
3
4
5
3. Carry out appropriate interventions in response to assessment findings
1
2
3
4
5
4. Identify and consult appropriate resources while assessing, planning (including prior to lab), and
implementing care.
1
2
3
4
5
4
5
4
5
5. Participate in group planning and decision making
1
2
3
6. Participate in analysis of group performance
1
2
3
Simulation Design Template
Appendix F
Student Evaluation for Acute Stroke Simulation
Please select the appropriate response on the Likert scale to indicate the extent to which you felt this
simulation met the learning activity objectives.
Strongly Disagree ----------------Disagree ---------------------Agree -----------------Strongly Agree
1
2
3
4
1. The simulation provided my group the opportunity to carry out a focused neurological assessment of a
patient who has a stroke using elements of the RNAO BPG “ Stroke Assessment Across the Continuum of
Care” and the Canadian Neurological Scale
1
2
3
4
2. The simulation provided my group the opportunity to identify assessment findings which could lead to
complications
1
2
3
4
3. The simulation provided my group the opportunity to carry out appropriate interventions in response to
assessment findings
1
2
3
4
4. The simulation provided my group the opportunity to identify and consult appropriate resources while
assessing, planning (including prior to lab), and implementing care.
1
2
3
4
1. The simulation provided my group the opportunity to participate in group planning and decision making
1
2
3
4
6. The simulation provided my group the opportunity to participate in analysis of group performance
1
2
3
4