Scenario Planning Template
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|Scenario Title: | |
| |Link curricular objectives to (state here): |
|Reason for development : | |
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|Level of Learner: | |
| |Organization Mission |
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|Target Duration: |Penn Medicine is a world-renowned academic medical center dedicated to |
| |discoveries that advance science, to outstanding patient care throughout|
| |the world, and to the education of physicians and scientists who carry |
|Author of Scenario: |on our legacy of excellence. |
| |Our combined missions of research, education, clinical care and |
| |community service improve health and well-being. We are proud of our |
| |commitment to service and strive to use discovery and rigorous research |
|Date: |to benefit our neighborhoods, our city and our world. We embrace the |
| |opportunity to teach others, to learn from our partners, and to care for|
| |patients with skill and dignity. |
|Learning Objectives: | |
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|Objective 1: | |
| |Core Competencies |
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|Objective 2: |PLEASE REFER TO FY19-20 BLUEPRINT FOR QUALITY AND PATIENT SAFETY WHEN |
| |LISTING YOUR COMPETENCIES |
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|Objective 3: | |
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|Confederate Roles and Names | |
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| |Patient Safety |
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|Facilitator Roles and Name | |
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| |GENERAL: |
|Setting: | |
| |Gloves____________ Sterile Gloves |
|Date: | |
| |IV Pole (quantity)_______ Mask (type)_______ |
|Time: | |
| |IV channels (quantity)________ Gowns #____________ |
|Location: | |
| |Hand Sanitizer Goggles |
|Role of the participant: | |
| |Patient Chart Booties |
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|Patient Information: |Patient Identification Band Caps |
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|Name: |Allergy Band |
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|DOB: |Alcohol Preps |
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|Medical Record Number: |Chlora Preps |
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|Allergies: |Suction source (quantity)___ Suction Tubing |
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|Height: |Suction Canisters |
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|Weight: |O2 source (quantity)_______ |
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| |Medical Air Flow meter |
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| |Resuscitation Cart |
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| |Anesthesia emergency cart |
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| |Type of simulator ____________________________ |
| |Be specific (ie Laerdal intubation head vs Sim Man 3G) |
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| |Type of bed (i.e.: OR table/ Hill Rom bed/ crib)_____________________ |
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| |Furniture (Bedside table/chairs/ couch)__________________________ |
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|Systems (for manikin set-up and facilitator use) | |
|Initial Scene (only include abnormalities) | |
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|Neuro: | |
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|Respiratory: | |
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| |Neurological Drains |
| |Neurological monitoring/cables (ie ICP) |
| |Other |
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| |Identify adult/ pediatric/neonate____________________ |
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| |Oral Airway |
| |Nasal Airway |
| |ETT (Size) |
| |LMA (Size) |
| |Self Inflating Bag |
| |Flow Inflating Bag |
| |Laryngoscope and blade –include size) |
|Cardiac: |Nasal Cannula |
| |O2 mask (types) |
| |Tracheostomy collar |
| |Bag valve mask |
| |Suction catheters(open or closed) |
| |Ventilator; What Type - |
| |Nebulizer |
| |Endo- or laparoscopic tower/camera/telescope |
| |Pulse oximeter |
| |Chest tubes (trocar and pleurevac) |
| |Tracheostomy tube and sizes (cuffed or no cuff) |
| |Tracheostomy care kits |
| |Hydrogen Peroxide |
| |Sterile water |
| |Sterile Saline |
| |ETT holder |
| |Other |
|GI | |
| |BP cuff |
| |ECG cables and electrodes |
| |A-line kit with set up (NS 500mL) |
| |A-line/ other hemodynamic cables |
| |Pressure bags |
| |Cordis |
| |Swan ganz catheter |
| |Central line kits |
| |Central line dressing kits |
| |Ultrasound (Siterite) |
| |Other |
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| |Nasogastric tube ( specify type) |
| |Gastric tube (specify types) |
| |Drains (specify types) |
| |Feeding pump and tubing |
| |Gastric feeds |
| |Sterile water |
| |Sterile NS |
| |Other |
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|GU | |
| |Straight cath kit (no drainage bag) |
| |Indwelling urinary catheter kit |
| |Condom catheter |
| |Other |
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|IV | |
| |IV solution volume and type and quantity |
| |IV solution type and type and quantity |
| |IV pump Alaris tubing (20gtts/mL) and quantity |
| |IV pump Alaris tubing with micron filter (20gtts/mL) |
| |IV micro drip tubing (gravity) 60htts/mL |
| |IV piggyback (secondary) tubing |
| |Mini infuser/ syringe pump tubing (indicate type) |
| |Blood pump tubing |
| |Blood gravity tubing |
| |Extension tubing |
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| |IV start kits |
| |Leur locks |
|Needles/Syringes |Other |
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| |3mL syringes |
| |5mL syringes |
| |10mL syringes |
| |20mL syringes |
| |30mL syringes |
| |60mL syringes |
| |10mL control syringes |
| |3mL syringe with needle |
| |5mL syringe with needle |
| |Other |
| |Other |
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| |Needles/syringe, Insulin, Vanish Point 29ga X ½’’ |
| |Needles, Insulin, SafetyGlide, 1mL 29ga X ½’’ |
| |Needles,/syringeTB, SlipTip 1mL 27ga X ½’’ |
| |Needles, /syringe TB, SafetyGlide, 1mL 27ga X ½’’ |
| |Needles, Injection, Safety Glide 21ga X 1 1/2 |
| |Needles, Injection, Safety Glide 23ga X 1 |
| |Needles, Injection, Safety Glide, 25ga X 1 5/8 |
| |Needles, Injection, Safety Glide 25ga X 1 |
| |I Needle, Filter 19ga X 1’’ W/5 micron filter |
| |Needles, Spinal 22ga X 1½’’I |
| |I Angiocath 22ga X 1.00’’ |
Meds:
Drug 1
Name
Drug concentration
Dose to be given
How supplied (ie: tablet, solution etc)
Drug 2
Name
Drug concentration
Dose to be given
How supplied (ie: tablet, solution etc)
Moulage (ie: secretions, urine, blood, simulated products):
Supplemental Media (e.g. photos or videos of skin appearance, EHR, X-rays, ECG, Echocardiogram, Endoscopy video,):
Supplemental References( pediatric formulary, educational references)
Confederate Roles:
Scenario Script (Page 1)
|Scenario Stage |Patient Condition/Information |Simulator Parameters |Expected Interventions/Actions |Simulator response to intervention |Scripted Participant/Actor Response |
| | | | |(indicate if response is over time |(if used) |
| | | | |period) | |
|Initial |Gen: |Vitals: | | | |
|assessment and | |ECG: | | | |
|decision |Airway: |HR: | | | |
| | |RR: | | | |
| |Breathing: |BP: | | | |
| | |SpO2: | | | |
| |Circulation: |ETCO2: | | | |
| | |Temp: | | | |
| |Disability: |Patient Condition: | | | |
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| |Exposure: | | | | |
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|Stage 2 |Change in condition: |Vitals: | | | |
| | |ECG: | | | |
| | |HR: | | | |
| |Labs: |RR: | | | |
| | |BP: | | | |
| | |SpO2: | | | |
| |X-Rays and Other diagnostics: |ETCO2: | | | |
| | |Temp: | | | |
| | |Patient Condition: | | | |
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|Stage 3 |Change in condition: |Vitals: | | | |
| | |ECG: | | | |
| | |HR: | | | |
| |Labs: |RR: | | | |
| | |BP: | | | |
| | |SpO2: | | | |
| |X-Rays and Other diagnostics: |ETCO2: | | | |
| | |Temp: | | | |
| | |Patient Condition: | | | |
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|Stage 4 |Change in condition: |Vitals: | | | |
| | |ECG: | | | |
| | |HR: | | | |
| |Labs: |RR: | | | |
| | |BP: | | | |
| | |SpO2: | | | |
| |X-Rays and Other diagnostics: |ETCO2: | | | |
| | |Temp: | | | |
| | |Patient Condition: | | | |
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Scenario Script (Page 2 – if needed)
|Scenario Stage |Patient Condition/Information |Simulator Parameters |Expected Interventions/Actions |Simulator response to intervention |Scripted Participant/Actor Response |
| | | | |(indicate if response is over time |(if used) |
| | | | |period) | |
|Stage 5 |Change in condition: |Vitals: | | | |
| | |ECG: | | | |
| | |HR: | | | |
| |Labs: |RR: | | | |
| | |BP: | | | |
| | |SpO2: | | | |
| |X-Rays and Other diagnostics: |ETCO2: | | | |
| | |Temp: | | | |
| | |Patient Condition: | | | |
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|Stage 6 |Change in condition: |Vitals: | | | |
| | |ECG: | | | |
| | |HR: | | | |
| |Labs: |RR: | | | |
| | |BP: | | | |
| | |SpO2: | | | |
| |X-Rays and Other diagnostics: |ETCO2: | | | |
| | |Temp: | | | |
| | |Patient Condition: | | | |
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|Stage 7 |Change in condition: |Vitals: | | | |
| | |ECG: | | | |
| | |HR: | | | |
| |Labs: |RR: | | | |
| | |BP: | | | |
| | |SpO2: | | | |
| |X-Rays and Other diagnostics: |ETCO2: | | | |
| | |Temp: | | | |
| | |Patient Condition: | | | |
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|Stage 8 |Change in condition: |Vitals: | | | |
| | |ECG: | | | |
| | |HR: | | | |
| |Labs: |RR: | | | |
| | |BP: | | | |
| | |SpO2: | | | |
| |X-Rays and Other diagnostics: |ETCO2: | | | |
| | |Temp: | | | |
| | |Patient Condition: | | | |
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Debriefing exercise outline:
|Phase |Inquiry/Script |Time |Notes made during simulation |
|Introductions |FACILITATOR: We are going to debrief together for about X minutes. | | |
| |During this time, I would like you to reflect on the scenario you just completed and, | | |
| |most importantly, I would like everyone to participate in the discussion. | | |
| |My role is to help facilitate, but not dominate the discussion. Before we begin, we | | |
| |should acknowledge that this was simulation, and we may have acted differently in real | | |
| |life. Now, let’s focus our discussions on our team interactions and the process of care | | |
| |delivered to the patient. | | |
|Reactions |FACILITATOR: Reactions? | | |
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| |FACILITATOR: Great. Other thoughts? ….Let’s talk about how you addressed issues around | | |
| |communication during the scenario. | | |
|Understanding phase: |FACILITATOR: [open-ended question] First let’s talk about how the team worked together. | | |
|CRM |Discuss how your group divided up the roles during the code. What went well, and what | | |
| |didn’t go well? | | |
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| |Specific teamwork/safety learning objectives: | | |
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| |FACILITATOR: Great, let’s move on to discussing the medical management. | | |
|Understanding Phase: |FACILITATOR: PARTICIPANT #1, you were the code leader. Why don’t you walk us through your| | |
|Medical Management |thought process around the medical management of this patient? | | |
| |Let’s talk about your assessment of the ABCs. What went well, and what didn’t go well. | | |
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| |Specific treatment learning objectives: | | |
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|Summary Phase |FACILITATOR: So to conclude, let’s identify the key learning points from the scenario. | | |
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| |To the group: What would you say are the 2 or 3 main take-home messages from the | | |
| |scenario? | | |
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| |Or, individually: Let’s go around and have each of you describe your main take-home | | |
| |message from the scenario. | | |
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