Tracheostomy Simulation Case Design
Audio Transcript Auto-generated
- 00:00 - 00:03
Hi my name is Vanessa jean and I will be presenting
- 00:03 - 00:09
a simulation case design focusing on a tracheostomy related emergency.
- 00:09 - 00:11
Um Specifically a trick dislodge mint.
- 00:13 - 00:18
So this simulation session was developed in response to nurses observation of
- 00:18 - 00:22
an influx of a more diverse patient population onto their unit.
- 00:22 - 00:27
And they specifically work on a hematology oncology unit
- 00:28 - 00:31
and they've noticed an influx of patients with solid organ malignancies.
- 00:31 - 00:34
And with this influx they've been
- 00:34 - 00:38
challenged with providing care that involves skills
- 00:38 - 00:42
in which their competencies are limited such as tracheostomy care.
- 00:44 - 00:46
So the institution we're learning will be
- 00:46 - 00:48
conducted as a teaching hospital that contains
- 00:49 - 00:52
a simulation center with multiple simulation labs.
- 00:52 - 00:55
Each simulation lab is set up similarly to a
- 00:55 - 01:00
patient's room and um learners have access to mannequins,
- 01:00 - 01:03
medical supplies such as tracheostomy straight care
- 01:03 - 01:06
kits and code cart's if needed.
- 01:08 - 01:11
The intended learners are all oncology nurses
- 01:11 - 01:13
with greater than one year of experience.
- 01:13 - 01:17
New graduate nurses are provided with a class that's similar
- 01:17 - 01:18
um to this one.
- 01:18 - 01:22
So therefore this class is intended to support more senior level
- 01:22 - 01:23
staff members who have limited
- 01:23 - 01:27
exposure and knowledge gaps regarding tracheostomy
- 01:29 - 01:31
with the necessary resources.
- 01:31 - 01:37
Um This session would require a lead stimulation instructor or debriefing
- 01:38 - 01:40
two simulation instructors that would serve as
- 01:40 - 01:43
a covering provider and a respiratory therapist.
- 01:44 - 01:45
Mannequin with a tracheostomy,
- 01:46 - 01:49
A tracheostomy kit and an additional or two
- 01:49 - 01:52
additional shyly tricks of a size six and 8
- 01:52 - 01:55
suction setup oxygen set up
- 01:55 - 01:57
crash cart,
- 01:57 - 02:01
continuous pulse oximetry monitoring and continuous telemetry monitoring
- 02:02 - 02:07
a monitor to display vital signs and an I. V pump as the patient will be receiving
- 02:07 - 02:08
I. V. Antibiotics.
- 02:09 - 02:13
So learners will be um top based surrounding
- 02:13 - 02:15
three different learning objectives.
- 02:15 - 02:17
And with these learning objectives we will be
- 02:17 - 02:21
assessing learners based off of critical actions.
- 02:21 - 02:22
So for the
- 02:22 - 02:24
first learning objective
- 02:24 - 02:28
it states upon completion of the scenario the learner will be able
- 02:28 - 02:31
to investigate signs of respiratory distress
- 02:31 - 02:34
associated with a dislodged tracheostomy.
- 02:35 - 02:37
And we are assessing whether the learners
- 02:37 - 02:39
are monitoring for breathing and ensuring that the
- 02:39 - 02:41
they have a patent airway
- 02:41 - 02:45
assessing oxygenation status with a full set of vital signs,
- 02:45 - 02:47
assessing lung sounds,
- 02:47 - 02:50
assessing the tracheostomy and secure mint
- 02:50 - 02:53
of external pieces and assessing whether they're
- 02:53 - 02:56
encouraging the patients to cough out secretions if they do have any?
- 02:56 - 02:59
And are they remaining with the patient throughout the emergency?
- 03:01 - 03:03
The second learning objective states at the
- 03:03 - 03:05
learning at the end of the learning session
- 03:05 - 03:08
the learner will be able to demonstrate
- 03:08 - 03:11
proper procedure to manage this large tracheostomy.
- 03:12 - 03:14
The critical actions we are assessing for.
- 03:14 - 03:19
Are the is the learner um calling the provider and giving report and S. Bar format.
- 03:19 - 03:24
Are they ensuring that the room is set up for a patient with a tracheostomy?
- 03:24 - 03:29
Are they providing trick care in accordance with the institution's policy?
- 03:30 - 03:33
Are they attempting to suction the airway as needed?
- 03:34 - 03:36
Are they changing the inner cannula?
- 03:36 - 03:38
If one is present.
- 03:39 - 03:43
Are they frequently assessing the status of the patient's airway
- 03:43 - 03:46
um that they locate the Ambu bag to ventilate the patient
- 03:47 - 03:50
and that they seek additional assistance by using
- 03:50 - 03:54
the staff assist or rapid response alert system.
- 03:54 - 03:58
The third learning objective states at the end of this session the learner
- 03:58 - 04:00
will be able to demonstrate productive and
- 04:00 - 04:04
professional behavior during a trick related emergency
- 04:05 - 04:07
critical actions that are paired with this. Are
- 04:07 - 04:09
are we assessing that the learner is
- 04:10 - 04:13
frequently assessing the status of the patient's airway?
- 04:13 - 04:17
Are they delegating roles to each team member during the staff,
- 04:17 - 04:19
assist or rapid response?
- 04:19 - 04:21
Are they utilizing effective communication
- 04:21 - 04:24
strategies with the interdisciplinary team
- 04:25 - 04:26
with the patient?
- 04:26 - 04:28
Um And
- 04:28 - 04:31
is the recorder during the rapid response
- 04:31 - 04:33
recording effectively.
- 04:35 - 04:37
The overall design um
- 04:38 - 04:43
consists of the simulation session being conducted in the sim center room 105.
- 04:43 - 04:46
There will be five learners to each session.
- 04:47 - 04:50
There will be a prebrief to orient learners to the environment.
- 04:50 - 04:55
We will be using a high fidelity mannequin that has a tracheostomy.
- 04:55 - 04:58
We will also be using embedded participants for the roles
- 04:58 - 05:02
of respiratory therapists and a covering provider in our case.
- 05:02 - 05:04
We have a physician assistant
- 05:05 - 05:07
and then we will debrief using
- 05:07 - 05:09
um the good judgment model.
- 05:10 - 05:13
So again learners will be pre brief for 10 minutes.
- 05:13 - 05:17
The simulation session will run over 15 minutes
- 05:17 - 05:19
and then we will debrief for 30 minutes.
- 05:21 - 05:24
We will also provide learners with an algorithm.
- 05:24 - 05:27
So learners and facilitators will be provided with
- 05:27 - 05:31
the emergency medicine clinics of North America's tracheostomy
- 05:31 - 05:35
de cancelation algorithm. I know that's a mouthful.
- 05:35 - 05:39
Um This will just guide learners throughout their interventions
- 05:39 - 05:43
while ensuring that they're providing evidence based care.
- 05:46 - 05:48
So we also expect the learners to fully
- 05:48 - 05:53
immerse themselves in the simulation session actively participate,
- 05:53 - 05:57
work effectively as a team and receive and provide feedback to both
- 05:58 - 06:00
their peers and the instructors
- 06:01 - 06:05
and for our evaluation plan. We'll be using three different tools.
- 06:05 - 06:07
The first tool is creating,
- 06:07 - 06:11
creating competency evaluation instrument and learners will be
- 06:11 - 06:14
evaluated by the debrief for to assess for
- 06:14 - 06:20
learning and it's a 23 item question and answers are given on a like Earth scale.
- 06:21 - 06:25
Second tool is the debriefing assessment for simulation in healthcare
- 06:25 - 06:30
and a debrief for will be assessed by an assigned clinical educator
- 06:30 - 06:35
for the effectiveness of their debriefing and educating skills.
- 06:35 - 06:38
And it's six questions also on the lid growth scale.
- 06:39 - 06:42
The last tool is the simulation effectiveness tool
- 06:42 - 06:47
And the learners will assess the overall effectiveness of the simulation
- 06:47 - 06:51
case and it's 20 questions also on a like earth scale.
- 06:53 - 06:55
So lastly I would like to know if anyone has any
- 06:55 - 06:58
questions and if you do please feel free to reach out
- 06:58 - 06:59
to me
- 07:00 - 07:02
and thank you all for listening and for your time.
- 07:03 - 07:03
Bye