It has been proven that students who received simulation-based training show statistically significant improvement in cognitive knowledge(1), both in the clinical and non-clinical settings
The aviation industry is a classic example of a field where simulation has been used in training for many years, providing realistic and safe environments to practice, learn new procedures, or to test new devices or workflows. The more realistic (or high fidelity) the scenario, the more the learner can immerse themselves into each situation.
The UCSF Medical Center Nursing Department has developed simulation education in preparation for the transition from a paper based Medication Administration Record (MAR) to an electronic MAR or eMAR with barcode scanning. This is equivalent to going from crawling to running, bypassing learning how to walk.
Why Sim Lab?
While the transition to an eMAR, that can be viewed by all clinicians, is a positive step for technology and an integrated enterprise solution for all--not to mention that it is the right thing to do for our patients and their families— the implementation requires great caution. This transition must not only be smooth, but also cannot compromise patient safety related to medication administration errors. To address this, traditional methods of online learning modules and classroom training are supplemented with mandatory simulation learning.
Sim Lab Model
The simulation team has developed a simulation area with patient rooms, medication areas, and separate debriefing rooms. Using high fidelity manikins that possess the ability to display various cardiac rhythms, physiological traits (e.g. cynanosis, tears, etc.), speech responses to questions controlled by operators, as well as many other features, we have created a realistic yet safe environment for clinicians to simulate medication administration in the new world, with eMAR and barcoding.
Workflows
Focusing on the majority of the medication workflows seen in acute care, critical care, and perioperative areas of both adult and pediatrics, clinical scenarios have been created to provide learners the ability to simulate administration of:
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Scheduled medications
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Insulin meds, requiring 2 RN independent checks
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IV fluids, including boluses
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PRN or as needed medications
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Emergently needed medications
Each class allows four learners to be facilitated by one instructor or facilitator. Simultaneously, four other learners engage in a facilitated viewing, allowing them to watch the learners perform medication administration and have more hands on time with the new devices. The two groups then change places and a group debriefing of the eight learners is led by the two facilitators at the end of the two-hour session. It is in the debriefing sessions, similar to nursing school clinical shift debriefings, where the discussion and critical thinking about the experience occurs.
What Makes This Different?
While the majority of the published research studies have addressed the use of simulation with pre-licensed clinicians for education of clinical scenarios(2), this simulation focuses on education of licensed nurses, respiratory therapists and pharmacists. In addition, Sim Lab is using technology to actually educate about technology.
Without a doubt, this trifecta of education requires time and resources, but a Chinese Proverb sums it up best: “Tell me and I will forget; show me and I may remember; involve me and I’ll understand.” --anonymous
Simulation Lab Planning Team
Lead
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Daphne Stannard, RN, PhD, CCRN, CCNS, FCCM - Clinical Nurse Specialist Perianesthesia and Associate Chief Nurse Researcher
Members
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Maureen Buick, RN, MS – Director of Nursing Education and Performance Improvement
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Adam Cooper, RN, MSN – Nurse Educator
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Craig Johnson, RN, MSN, FNP – Patient Care Services Clinical Information Coordinator
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Melissa Lee, RN, MS, GCNS-BC – Adult Medical / Surgical Clinical Nurse Specialist
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Sandy Ng, RN, MSN, RN-BC – Patient Care Services Clinical Information Coordinator
Additional Operations Team Members
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An-Nhien Le, RN, BSN – Administrative Assistant
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Nina Manke, RN, MS – Sim Lab Coordinator
References:
1 - Pamela R. Jeffries, Michael Beach, Sharon I. Decker, Lucie Dlugasch, Jeffrey Groom, Julie Settles &John M. O'Donnell (2011) Multi-Center Development and Testing of a Simulation-Based Cardiovascular Assessment Curriculum for Advanced Practice Nurses. Nursing Education Perspectives: September 2011, Vol. 32, No. 5, pp. 316-322.
2 - Jan L. Partin, Teresa A. Payne & Marina F. Slemmons (2011) Students' Perceptions of Their Learning Experiences Using High-Fidelity Simulation to Teach Concepts Relative to Obstetrics. Nursing Education Perspectives: June 2011, Vol. 32, No. 3, pp. 186-188.
