Create Your Own
Simulations and
Evaluate Them
T EA M STEP PS® N AT I ONAL CON F E R ENCE
DA L L A S, T X

JUN E 1 3 , 2 0 ...
Introductions
o Steve Powell, MS
o Melisa Powell, MS, RN-BC
o Julie Gapstur, RN, BSN
o Daniel Baily, MS
Click Image to Follow Link to Resource
Objectives
o To know and be able to develop TeamSTEPPS training scenarios
o To understand the process of developing TeamST...
Program Evaluation
of In Situ
Simulation-Based
Team Training
MELISSA POWELL MS, RN -BC
Start at the End - Use a Backwards
Planning Model
o Start with a needs assessment. Identify best practices.
o Determine wh...
My Story
o Vanderbilt Hospital has a weekly meeting with unit leaders to debrief
all RRT calls that occur on medicine unit...
What Did the Nurses Say?
o

o

o

“He or she {physician} is right here at the bedside with
me, and that feels very uncomfo...
Desired Outcomes for the Project

Rapid Response called:

1. When Appropriate - Accuracy
2. In a Timely Manner - Timelines...
What I Did Use as a Measure
How frequently was there a delay to call or failure to call
Using Simulation and Video as a Tool for
Evaluating Behaviors
Using a Checklist as an Evaluation Tool
Frequency Count
Communication

Positive Instances

Check-back
Call-outs

SBAR
Unintelligible Communications

Mutual Suppor...
Using Debriefing as an Evaluation Tool
o The Facilitator should role model creating a debrief climate with
psychological s...
Play Video of Debrief
Program Evaluation
Post code data
& # of Failure to
Rescue events

Survey

Real event

Intervention
group (100%)

Debrief
...
Post Training Survey
Beacuase of this simulation event I have learned new communication
techniques that I will employ in m...
Simulation Checklist Results
o BLS skills (80%)

o Procedural knowledge (50%)
o Equipment knowledge (unable to assess duri...
Number of Delay and/or Failure to Rescue
18

Control Unit

12
23

Invervention Unit

6
0

5

10

January 2010 to July 2010...
Performance Outcomes Analysis
o Debriefing nurses post intervention yield stronger self reflective ability
o Using concept...
Role-play Simulation Exercise
TeamSTEPPS,
Simulation and the
Power of Debriefs
A POWERFUL COMBINATION
JULIE GAPSTUR, RN, BSN
Partnership for Patients Alignment
o Aims:
◦ To reduce patient harm by 40 percent by 2013
◦ To reduce hospital readmission...
Our Collaborative Goals
o 95% providers and staff participation in a team-based simulation
module
o Increase Labor and Del...
Why TeamSTEPPS and Simulation?
Simulation and Team Training
Teams experience the difference
between knowing what they are
supposed to do & doing what the...
What we Did…

Simulation Training
that is focused
on TeamSTEPPS &
DEBRIEFING
Why Debrief?
o Teams that debrief effectively
build shared understanding
(mental models) and perform
up to 40% better
o Gu...
How we did it….
TeamSTEPPS Essentials Training
Training on HOW TO DEBRIEF
Use multiple levels of Simulation Fidelity
Famil...
Building the Scenario
“Show and Tell”
The Simulation Event
Mama Natalie - Low Fidelity
Pre-Simulation Briefing
1. Introduce Staff

2. Review Roles
Pre-Simulation
Briefing by Facilitator

3. Review Equipment

4...
Shoulder Dystocia –
High Fidelity with SimMom™
What is a Debrief?
Debriefs are team events used to:
◦ Review individual and team
performance
◦ Identify errors made
◦ Rec...
Structured Debrief Checklist
1.

What went well, and why?

2.

What didn’t go so well, and why?

3.

What would we do diff...
Tips for Debriefing
Be a FACILITATOR, not an INSTRUCTOR –

Get Them To Talk

Keep it Simple – Three Questions

Show the Vi...
Application
What will it take to implement debriefs with your team?
◦ Identify a facilitator.
◦ Give all team members a vo...
Teamwork Actions
o Conduct debriefs.
o Empower team members to
speak freely and provide
feedback.
o Focus on teamwork and ...
Simulation Learnings – ‘Ah-Ha’ Moments
1. Tell them, show them, let them practice
2. Make sure your facilitators are not o...
Implementation Confidence –
Training Site #4

N = 22
Simulation Confidence – Training Site #2

N = 16
TEAMS THAT DEBRIEF –
PERFORM BETTTER!
Looking through the Windshield instead of the Rear View Mirror
Helps turn your team of experts…

into an expert team
Q&A
References
o
o
o
o
o
o
o

o
o

o
o

o

o
o
o

Bandura. (2001). Social cognitive theory: An agentic perspective. Annual Rev...
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TeamSTEPPS 2013 Presentation "Create your own simulations and evaluate them"

  1. 1. Create Your Own Simulations and Evaluate Them T EA M STEP PS® N AT I ONAL CON F E R ENCE DA L L A S, T X JUN E 1 3 , 2 0 1 3
  2. 2. Introductions o Steve Powell, MS o Melisa Powell, MS, RN-BC o Julie Gapstur, RN, BSN o Daniel Baily, MS
  3. 3. Click Image to Follow Link to Resource
  4. 4. Objectives o To know and be able to develop TeamSTEPPS training scenarios o To understand the process of developing TeamSTEPPS performance measures for Simulation o Identify the role debriefs play in promoting team self-correction, process improvement, and patient safety. o Recognize the importance of reflection, measurable performance objectives, and psychological safety during the debrief. o Recognize the importance of empowering individual team members to discuss shared team performance and process outcomes during the debrief.
  5. 5. Program Evaluation of In Situ Simulation-Based Team Training MELISSA POWELL MS, RN -BC
  6. 6. Start at the End - Use a Backwards Planning Model o Start with a needs assessment. Identify best practices. o Determine what will be acceptable evidence of current performance. o Examples: ◦ Practice data - Unit data ◦ Published data about clinical performance ◦ Interviews – Focus groups – Unit request
  7. 7. My Story o Vanderbilt Hospital has a weekly meeting with unit leaders to debrief all RRT calls that occur on medicine units. ◦ Began to Review all RRT’s called on unit ◦ Appeared to be delays in calling ◦ Nurse were not calling RRT (even when medically appropriate)
  8. 8. What Did the Nurses Say? o o o “He or she {physician} is right here at the bedside with me, and that feels very uncomfortable as though it says to the physician that I do not think they are capable.” “He or she went to medical school. I didn’t. I’m just a nervous new nurse. They know what they are doing.” “The nurses just roll their eyes at me and don’t do anything!”
  9. 9. Desired Outcomes for the Project Rapid Response called: 1. When Appropriate - Accuracy 2. In a Timely Manner - Timeliness
  10. 10. What I Did Use as a Measure How frequently was there a delay to call or failure to call
  11. 11. Using Simulation and Video as a Tool for Evaluating Behaviors
  12. 12. Using a Checklist as an Evaluation Tool
  13. 13. Frequency Count Communication Positive Instances Check-back Call-outs SBAR Unintelligible Communications Mutual Support Two-Challenge CUS Task Assistance Positive Instances
  14. 14. Using Debriefing as an Evaluation Tool o The Facilitator should role model creating a debrief climate with psychological safety. o Learners should be asked to express what they will take forward into their daily practice based on the simulation experience. o (EXIT TICKET!)
  15. 15. Play Video of Debrief
  16. 16. Program Evaluation Post code data & # of Failure to Rescue events Survey Real event Intervention group (100%) Debrief Post code quality survey Online Education Simulation # Failure to Rescue events Source: Moore’s Method
  17. 17. Post Training Survey Beacuase of this simulation event I have learned new communication techniques that I will employ in my practice. 7% 20% 73% Strongly Disagree Please rate the simulation as a method to practice/reinforce your teamwork skills. 7% Strongly Agree 14% 79% Poor Unit based simulations helped build my confidence in my teammates for a real life code situation. 7% 0% Bottom Quartile Excellent 3rd Quartile 93% Strongly Disagree 10% 20% 30% 2nd Quartile 40% 50% Top Quartile 60% 70% Strongly Agree 80% 90% 100%
  18. 18. Simulation Checklist Results o BLS skills (80%) o Procedural knowledge (50%) o Equipment knowledge (unable to assess during due to SimMan3G barriers) o Assessment and Intervention (99%) o Recognizing and Initiating RRT immediately (55%) o Communication skills ◦ SBAR (20%) ◦ CUS (.1%) ◦ Check Back (34%) ◦ Two-Challenge Rule (0%) ◦ Situation Monitoring including Shared Mental Model knowledge (34%) .
  19. 19. Number of Delay and/or Failure to Rescue 18 Control Unit 12 23 Invervention Unit 6 0 5 10 January 2010 to July 2010 15 20 25 January 2011 to July 2011 January 2010 to July 2010 January 2011 to July 2011 Percent Change Invervention Unit 23 6 -117% Control Unit 18 12 -40%
  20. 20. Performance Outcomes Analysis o Debriefing nurses post intervention yield stronger self reflective ability o Using concepts such as authority gradient to communicate what they experienced o Staff now often identifies their own barriers and role in early activation and failure to rescue
  21. 21. Role-play Simulation Exercise
  22. 22. TeamSTEPPS, Simulation and the Power of Debriefs A POWERFUL COMBINATION JULIE GAPSTUR, RN, BSN
  23. 23. Partnership for Patients Alignment o Aims: ◦ To reduce patient harm by 40 percent by 2013 ◦ To reduce hospital readmissions by 20 percent by 2013 Harm includes OB Adverse Events
  24. 24. Our Collaborative Goals o 95% providers and staff participation in a team-based simulation module o Increase Labor and Delivery team debriefs following an unscheduled cesarean delivery, after handoff to OR, to 95% o 5% overall improvement in dimension scores or achievement of 5% or more above the National OB benchmark average on the AHRQ Hospital Survey on Patient Safety Culture o + other clinical outcomes
  25. 25. Why TeamSTEPPS and Simulation?
  26. 26. Simulation and Team Training Teams experience the difference between knowing what they are supposed to do & doing what they are supposed to know Courtesy: Paul Preston, MD Kaiser-Permanente
  27. 27. What we Did… Simulation Training that is focused on TeamSTEPPS & DEBRIEFING
  28. 28. Why Debrief? o Teams that debrief effectively build shared understanding (mental models) and perform up to 40% better o Guided team debriefs improve performance through selfcritique and problem-solving o Teams that debrief are able to uncover and identify problems earlier than other teams Smith-Jentsch, et al., 2008 28
  29. 29. How we did it…. TeamSTEPPS Essentials Training Training on HOW TO DEBRIEF Use multiple levels of Simulation Fidelity Familiarization with Simulation devices Faculty Simulation exercise Participant Simulation exercises Simulation evaluation
  30. 30. Building the Scenario
  31. 31. “Show and Tell”
  32. 32. The Simulation Event
  33. 33. Mama Natalie - Low Fidelity
  34. 34. Pre-Simulation Briefing 1. Introduce Staff 2. Review Roles Pre-Simulation Briefing by Facilitator 3. Review Equipment 4. Review Goals
  35. 35. Shoulder Dystocia – High Fidelity with SimMom™
  36. 36. What is a Debrief? Debriefs are team events used to: ◦ Review individual and team performance ◦ Identify errors made ◦ Recognize best practices ◦ Develop a plan to improve ◦ Promote continuous learning and process improvement DEBRIEFS ARE NOT JUST FOR SIMULATION! 36
  37. 37. Structured Debrief Checklist 1. What went well, and why? 2. What didn’t go so well, and why? 3. What would we do differently? FOCUS ON TEAM SKILLS! Remember, redirect debrief if the focus is on processes, ‘simisms’, or clinical skills
  38. 38. Tips for Debriefing Be a FACILITATOR, not an INSTRUCTOR – Get Them To Talk Keep it Simple – Three Questions Show the Video – When Needed (if team is unable to self reflect.) Be Comfortable with Silence Focus on Team Skills – NOT Clinical Skills – Redirect the Debrief if Needed.
  39. 39. Application What will it take to implement debriefs with your team? ◦ Identify a facilitator. ◦ Give all team members a voice in the process. ◦ Treat debriefs as learning opportunities, not opportunities for assigning blame. ◦ Focus on process improvement and future performance.
  40. 40. Teamwork Actions o Conduct debriefs. o Empower team members to speak freely and provide feedback. o Focus on teamwork and task work processes. o Use a tool to evaluate team performance and facilitate discussion. o Record and trend team performance.
  41. 41. Simulation Learnings – ‘Ah-Ha’ Moments 1. Tell them, show them, let them practice 2. Make sure your facilitators are not only content experts, but well seasoned facilitators 3. Stick to the script in debriefing 4. Plan in advance – but be flexible 5. Make it fun! Don’t be surprised if you see laughing – this is “serious play!” 6. Don’t be afraid of improvisation
  42. 42. Implementation Confidence – Training Site #4 N = 22
  43. 43. Simulation Confidence – Training Site #2 N = 16
  44. 44. TEAMS THAT DEBRIEF – PERFORM BETTTER! Looking through the Windshield instead of the Rear View Mirror
  45. 45. Helps turn your team of experts… into an expert team
  46. 46. Q&A
  47. 47. References o o o o o o o o o o o o o o o Bandura. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52(1), 1. Clancy, C. M. (2007). TeamSTEPPS: assuring optimal teamwork in clinical settings. American journal of medical quality, 22(3), 214. Gaba, D. M. (2004). The future vision of simulation in health care. Quality & Safety in Health Care, 13(suppl 1), i2. Holzman, R. S. (1995). Anesthesia crisis resource management: real-life simulation training in operating room crises. Journal of clinical anesthesia, 7(8), 675. Kolb, D. A. (1983). Experiential Learning: Experience as the Source of Learning and Development (1st ed.). Prentice Hall. Miller, K. K. (2008). In situ simulation: a method of experiential learning to promote safety and team behavior. The Journal of perinatal & neonatal nursing, 22(2), 105. Moore, D. E., Green, J. S., & Gallis, H. A. (2009). Achieving desired results and improved outcomes: Integrating planning and assessment throughout learning activities. Journal of Continuing Education in the Health Professions, 29(1), 1–15. doi:10.1002/chp.20001 Nunnink, L. (2009). In situ simulation-based team training for post-cardiac surgical emergency chest reopen in the intensive care unit. Anaesthesia and intensive care, 37(1), 74–8. Peberdy, M. A., Callaway, C. W., Neumar, R. W., Geocadin, R. G., Zimmerman, J. L., Donnino, M., Gabrielli, A., et al. (2010). Part 9: Post– Cardiac Arrest Care 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 122(18 suppl 3), S768–S786. doi:10.1161/CIRCULATIONAHA.110.971002 Rogers, E. M. (1995). Diffusion of innovations. Free Press. Rudolph, Jenny, W. (2006). There’s No Such Thing as “Non-judgmental” Debriefing: A Theory and Method for Debriefing with Good Judgement. Simulation in Healthcare, 49–55. Salas, E., DiazGranados, D., Klein, C., Burke, C. S., Stagl, K. C., Goodwin, G. F., & Halpin, S. M. (2008). Does Team Training Improve Team Performance? A Meta-Analysis. Human Factors: The Journal of the Human Factors and Ergonomics Society, 50(6), 903–933. doi:10.1518/001872008X375009 Small, S. D. (2008). Demonstration of high‐fidelity simulation team training for emergency medicine. Academic emergency medicine, 6(4), 312. Vanderbilt Policy Rapid Response Team Activation Policy number CL 30-08.16 Vanderbilt Policy Cardiopulmonary Resuscitation Policy number CL 30-08.21.

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