SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Name Tylenol Overdose Resident Nurse
Goal: Medication Overdose Tylenol
Measurable Objectives (minimum 2, maximum 10)
1. Identify signs and symptoms of a Tylenol overdose.
2. Demonstrate proper use of SBAR to report Tylenol Overdose to Physician.
3. Recognize medication allergy and ask for alternate medication.
Authors:
Peter Ford Bates Technical College
Carly Williams Northwest Hospital & Medical Center
Date Submitted Spring 2013
Expected Scenario Time: 15 min
Expected Debrief Time:
30 min
Target Audience: RN/Less than one year practice
Report and Information Provided To Participants Prior To Simulation
Jerry Williams is an aeronautical engineer transferred from Seattle to Chicago one year
ago when his company relocated. Flies home monthly to see family. Recent history of
increased alcohol consumption, 3-5 beers a night. Weight gain due to poor diet and not
exercising. History of hypertension. Controlled with Lisinopril. In the Emergency
Department with complaints of flu like symptoms for 4 days. Change of shift report
Temp 102F, severe nausea, vomiting, and diarrhea, increased complaints of abdominal
pain, x-ray normal awaiting cat scan.
Patient Information
Patient Name:
Age:
Jerry Williams
Gender:
Male
49
Birth date:, June 17, 1964
Weight: 210
Height: 70 IN
ID band MR #00001234 Acct. # 1198765432
Hx. Present Illness: Coronary Artery Disease
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
Social History: Recently relocated for work, living apart from family. Recent
history of alcohol and smoking abuse since relocation. Recent weight gain due to
poor diet.
Religion: Agnostic
Support System: Family lives out of state. Allergies: Morphine
Attending Physician: Sylvia Oberholtzer Past medical history:
Hypertension.
Physical description of how you want the manikin to present at start of scenario?
Moulage: sweating, holding stomach
Assignment Of Roles (Please indicate below roles to be assigned):
Primary Nurse
Family Member #1
Secondary Nurse
Observer(s)
Important Information Related To Roles:
Family Member - overly protect and worried for patient's illness
Fidelity (choose all that apply to this simulation)
Setting/Environment
ED
Props:
Equipment attached to manikin:
Primary IV Fluid running at 125 LR ml/hr
O2 Nasal Cannula
Monitor attached/ Type
ID band
Equipment available in room:
Crash cart c airway devices and emergency meds
IV start kit
IV tubing
Other Props:
Empty bottle of Tylenol and Alka Seltzer
Medications and Fluids:
Oral Meds/ Home Meds:
- Tylenol
- Lisinopril
Documentation Forms:
Admit Orders
Physician Orders
MAR
Recommended Mode for Simulation
Manual/Programmed Hybrid
Manikin to be used SimMan3G or Standardized
patient.
Physician Orders IV LR, Morphine Sulfate, 1mg
SubQ every 4 hours for pain. Zofran, 8mg IV push
PRN nausea. NPO
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
Scenario Progression Outline
Stage 1
Initial Amount
Time in Initial
Stage- 5 mins
Baseline Vital Signs
T PR 101-90-22
BP 150/92
SPO2 - 92
Cardiac Rhythm
Sinus
Breath Sounds
Crackles
Heart Sounds
Normal
Abdominal Sounds
Hyperactive
Other Symptoms:
Eyes open
Verbalization
(Pt/Manikin
Cues)
Dont feel well
- severe
stomache
-I’ve been
vomiting for a
few days.
-Can you give
me something
for the pain.
-Tylenol
helps.
Expected
Interventions
-Assess
abdomen.
-Take vital
signs
-Inform
patient NPO
no Tylenol
should be
taken.
-RN will
provide pain
med.
Alternate or Incorrect
Treatment Choice
That Will Affect Outcome
-Pain will continue and
diarrhea.
Correct Treatment Choice:
Stage 2
Timing Sequence
15 Minutes Later
Baseline Vital Signs
T 99
P 84
R 22
BP 134/82
SPO295
Cardiac Rhythm Sinus
Breath Sounds Crackles
Heart Sounds Normal
Abdominal Sounds Active
Other Symptoms:
Verbalization
Can you please give me some of those Alka Seltzer
Plus meds?
That helps with my heartburn and burping. I take a
couple pills every morning to ease my headache.
Confederate
Actions/Additional
Role Player Cues
-I just gave him a
couple of Tylenol. I
didn't know he couldn't
have them.
-Well it’s good anyway.
The bottle is empty.
Expected Interventions
Monitor patient and identify
stabilization of vital signs and level of
pain.
-RN should assess amount of
medication taken at home.
-Family member says we tried giving
him the Alka Seltzer and the Tylenol
but it wasn’t enough to make him feel
better.
If RN doesn’t respond Family member
can say:
-Family member saysHe took a bottle
of Tylenol over 3 days and most of the
Alka Seltzer Plus. Do you think that
little shot is going to make him feel
better than all of those pills?
RN should explore home medications
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
taken with Pharmacist/ Charge RN.
SBAR report to the ARNP or MD with
a concern of Acetaminophen overdose.
MD will order lab work. Chem screen,
CBC, PTT, PT, Liver function tests.
Acetaminophen level.
RN should review orders with Charge
RN. Complete orders stat.
Monitor vital signs I&O Assess for
signs of Liver Failure.
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)
In debrief talk about labs, allergies, and Tylenol overdose. Acetylcysteine 150 mg/kg in 200mL
D5W IV over 60 minutes decrease to 50 mg/kg in 500 mL’s over 4 hours.
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:
www.micromedexsolutions.com
http://www.ncbi.nlm.nih.gov/pubmed/23247304
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
Medication Administration Record
As Needed Medications
Diagnosis
Room/Bed#
Drug, Dose, Route, Frequency
2400-0659
0700-1459
1500-2359
Printed name
Initials Printed Name
Initials Printed Name
Initials
Printed Name
Initials Printed Name
Initials Printed Name
Initials
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
Medication Administration Record
Scheduled Medications
Diagnosis
Room/Bed#
Drug, Dose, Route, Frequency
2400-0659
0700-1459
1500-2359
Printed name
Initials Printed Name
Initials Printed Name
Initials
Printed Name
Initials Printed Name
Initials Printed Name
Initials
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
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