SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Name Medication Overdose/Hypoxia Duramorph, Senior Level
Measurable Objectives (minimum 2, maximum 10)
1. Demonstrate Assessment of a patient in respiratory distress.
2. Demonstrate respiratory support with increase in oxygen satuartion
3. Identifies and administers duramorph to decrease respiratory distress and increase
oxygen saturation.
Authors:
Peter Ford Bates Technical College
Carly Williams Northwest Hospital & Medical Center
Date Submitted April 2013
Will There Be Any Pre-Simulation Lecture? Review prior to simulation: Clinical
pharmacology of Duramorph.
Expected Scenario Time 15 minutes Expected Debrief Time
30 minutes
Report and Information Provided To Participants Prior To Simulation
Nicole Winslow is a 47 year old female, who fell yesterday at home. She fractured her
left hip and had total hip replacement, due to pathological nature of fracture. She has a
history of melanoma, that was in control up to this fall. She received a Duramorph
injection last night at 8pm. She has a left hip dressing dry and intact, and her neuro
vascular check was good. IV LR at 125ml/hour, VS stable. She has been sleepy but
arouses easily. She ate breakfast with no c/o nausea. Plan for up to the chair with
Physical Therapy this am.
Patient Information
Patient Name:
Age:
Mrs. Winslow Gender: Female
Weight: 150
47
Birth date:, March 11 1966
Height:
5'4"
ID band MR #00001234 Acct. # 1198765432
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
Hx. Present Illness: Fell at home fx left hip
Social History:
No etoh or smoking, lives with son, divorced 2 children
Support System: Lives with son
Allergies:NKA
Past medical history: Melanoma
Physical description of how you want the manikin to present at start of scenario?
Moulage: Dressing on left hip
Assignment Of Roles (Please indicate below roles to be assigned):
Primary Nurse
Secondary Nurse
Family Member (optional) Daughter and son-in-law
Observer(s)
2
Unlicensed Assistive Personnel/CNA/MA
Important Information Related To Roles:
Please provide script and sequence to patient, daughter and son-in-law.
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
Setting/Environment
Medical-Surgical Unit
Medications and Fluids:
Other Narcan
Props:
Equipment attached to manikin:
Primary IV Fluid
running at 125 ml/hr
PCA and or IV pump running: Morphine
O2 equipment
Monitor attached/ Type: Oxygen Saturation
Other Patient room with chairs for team and family
members
Equipment available in room:
Crash cart
Other Reconcilled list of medications
Diagnostics Available:
Other:
Documentation Forms:
Progress note and abbreviated admission form,
MAR
Other Flow sheets, Brochures
Order Sheet or Protocol for Narcan
PCA Opiate Protocol
Recommended Mode for Simulation
Manikin to be used SimMan3G
Scenario Progression Outline
#1
Initial Amount
Time in Initial
Stage- 5-7 mins
Baseline Vital
Signs
T PR 37-66-10
BP 105/66
SPO294
Cardiac Rhythm
Breath Sounds
Heart Sounds All
normal
Abdominal Sounds
Hypoactive
Verbalization (Pt Cues)
and Actions
Expected
Interventions
Confederate
Actions/Additional Role Player Cues
Responds to
stimulation but is a lttle
groggy
Complete basic
patient assessment,
May delegate
Secondary RN or
CNA to complete
vital signs, may
encourage patient
to breath deeply,
see if they can
waken them more
Family Member (optional): She is
sleeping. Please let her sleep.
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
Stage 2
Basic Assessment
has been
completed.
(approx. 57minutes into
scenario)
Baseline Vital
Signs
T 37
P 66
R 10-7 trending
over 2 minutes
BP 104/62
SPO290-84
trending over 2
minutes
Cardiac Rhythm
Breath Sounds
Heart Sounds All
normal
Abdominal Sounds
Hypoactive
Stage 3
2 Minutes after
Narcan is
administered
Baseline Vital
Signs
T 37
P 66 trends up to
78 over 2 minutes
R 7 trends up to
12 over 2 minutes
BP 112/68
SPO282-95
trending for 3
minutes
Cardiac Rhythm
Breath & Heart
Sounds Normal
Abdominal Sounds
Hypoactive
Verbalization (Pt Cues)
and Actions
Expected
Interventions
Confederate
Actions/Additional Role Player Cues
Patient is not
responding. Snoring
and/or agonal breathing
Apply O2, Call for
extra help (Rapid
Response Team),
provide Narcan
Family Member (optional): Is she
dying? Why won’t she wake up.
RN: SBAR report
Verbalization (Pt Cues)
and Actions
Expected
Interventions
Confederate
Actions/Additional Role Player Cues
What happened? I am
having a little pain
now and didn’t before.
Reassess Vital
Signs and explain
to patient why they
are having pain
Family Member (optional): What was
that you gave her? I think its working.
But why is she in pain again?
Rate pain on 0-10
pain scale.
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
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).
5
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).
6
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).
7
SIMULATION DESIGN & PLANNING TEMPLATE
Resources:
Reisine T & Pasternak G: Opioid analgesics and antagonists. In: Goodman & Gilman's The
Pharmacological Basis of Therapeutics, 9th ed. McGraw-Hill, New York, NY, 1995; 521-555
American Society of Anesthesiologists Association, http://www.asahq.org/
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