Simulation of Code Stroke Jenny Simmonds, RN Simulation Program - - PDF document

Simulation of Code Stroke Jenny Simmonds, RN

Simulation Program Manager, Registered Nurse, Intermountain Healthcare; Salt Lake City, UT Objectives:

• Identify the history of development of simulation within

Intermountain Healthcare

• Describe simulation can help you reach high reliability of care for the

acute stroke patient

• Practice simulation demonstration of the NIH scale

Why Simulation?

Lessons Learned from Time “In the Box”

Angie Kahoush MSN, RN

South Region Simulation Manager

Phillip Wortham BA

System Simulation Manager for Operations and Technology

Disclosure

No financial conflicts to disclose

Objectives

• Why Simulation? Explore what healthcare can learn from Aviation

Teamwork and Safety

• Discuss the Intermountain Healthcare simulation structure/updates
• Discuss Improvement in engagement of signature initiatives through

simulation

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Simulation Training

Methodology for learning in which trainees are:

• Immersed in a realistic

scenario

• THINK, TALK and DO
• Go beyond comfort level
• Reflect on performance in

debriefing following scenario

• Trained as a team
• No better place to make a

mistake

When I do it correctly; I gain experience. When I do it poorly; wisdom. Mistakes are the portals of discovery.”

‐James Joyce (Irish Poet)

Developing Evidence

“A growing body of evidence shows that clinical skills acquired in medical simulation laboratory settings transfer directly to improved patient care practices and better patient outcomes.”

(Academic Medicine June 2011)

Simulation Training

• Aviation
• Nuclear power
• Military
• Law Enforcement

These industries have very low failure rates considering the inherent risks, but it wasn’t always so…

United Airlines Flight 173

Portland, Oregon 12/28/1978

• Flight from New York to Portland,

stopped in Denver

• 46,700 lbs fuel when departed

Denver, 31,900 lbs needed to reach Portland

• Crashed 6 miles from

Portland airport

• Spent 54 minutes spent

troubleshooting

• Flight engineer questioned fuel

levels 38 minutes into troubleshooting process

• 10 killed including flight engineer,

23 seriously injured

Lessons Learned

“Crew members must be proactive, coordinating individual efforts to yield effective team performance… As with athletics, a group of individuals with superior talent may be bested by another group of more modestly talented individuals who work together successfully as a team.”

‐Donald Davis , Pilot, Author

The risk associated with a team’s preoccupation with an emergency can exceed the risk posed by the emergency itself. In this case, the crew spent 54 minutes troubleshooting a problem that was not the primary problem…

Cockpit Resource Management (CRM)

1979 NASA research identified that human error was the primary cause of most aviation accidents…

Human errors that lead to the majority of air crashes:

• Interpersonal communication
• Decision making
• Leadership
• Teamwork
• Problem Solving

Aviation on Burning Platform

We change because the price of staying on the platform is too high. Radical change in people

• nly comes when survival

instincts trump comfort zone instincts.

Relation to Healthcare

– Inherent risk to human life – Direct relationship between actions and outcomes – Technical skills are vital – Communication is primarily verbal and immediate – Involves multiple personnel – Human interface with technology – Tradition of senior pilot and Physician as commander in chief

Cockpit Resource Management to Crisis Resource Management

Developed by team

• f anesthesiologists

in 1990

Communication Global Assessment Role Clarity Personnel Support Resources

Our “Burning Platform”

• 2014 issue in Journal of Patient Safety

report numbers ranging from 210,000 to 400,000 deaths/yr.

• 3rd leading cause of death 2nd to heart

disease and cancer. Odds of dying in a plane crash: 1 in 14 million

John Hansman Jr., Director MIT International Center for Transportation

( 761 deaths from airline crashes in 2014)

‐Aviation Safety Network

Relation to Healthcare

“Many of these poor

• utcomes are not due to

inadequate medical knowledge, but to problems transforming that knowledge into meaningful clinical actions under the real world conditions of patient care.”

(Rall & Dieckmann)

Why would we not use Simulation?

How can Simulation Help?

Simulation allows participants an opportunity to practice real world situations (CRM) in a safe environment where there is no risk of harm to patients, thus bridging the gap between learned knowledge and real life application.

Debriefing with Good Judgment

Potential + Training – Interference = High Performance PO + T – I = HP

• Practice makes permanent
• Navigate in the critical moment
• Help employees acquire skills = Permanently changing people
• No individual is perfect….but you can have a perfect team

Miracle on the Hudson

January 15, 2009 “I had to force myself to use my training and enforce calm on the situation… my entire life up to that moment had been in preparation to handle that particular moment.”

Pilot Chesley Sullenberger

"One way of looking at this might be that for 42 years, I've been making small, regular deposits in this bank of experience: education and training. On January 15, the balance was sufficient so that I could make a very large withdrawal."

‐Chesley Sullenberger

Intermountain Healthcare Simulation

VIDEO