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Simulation Design TemplateDate: 6-6-13 (author: Patty West)File Name: Medication Administration Distraction Using Second LifeDiscipline: NursingStudent Level: Fundamentals CourseFirst semester; JuniorsExpected Simulation Run Time: 20 minutesGuided Reflection Time: 20 minutesLocation: Technology Simulation LabLocation for Reflection: Classroom/Debriefing roomAdmission Date: 4-12-13Today’s Date: 4-14-13Brief Description of Client:Name: Patterson, Michael Gender: Male Age: 63 Race: CaucasianWeight: 258 lbs. Height: 72 inchesReligion: Methodist Major Support: spousePhone: (898) 123-4567Allergies: SulfaImmunizations: Influenza & pneumonia last yr.Attending Physician/Team: Dr. Y. BonesPast Medical History: A-fib, NIDDM, PVD, gastric refluxHistory of Present illness: s/p LTKASocial History: 1 drink per month; no smoking hx., no illicit drug use.Primary Medical Diagnosis: s/p LTKASurgeries/Procedures & Dates: RTKA 2000, Hernia repair 1990Psychomotor Skills Required Prior to Simulation:Medication Administration PracticeComplete Pyxis Tutorial in plete Second Life Portal Registration & create avatarComplete Nursing Health Island Orientation materials (e.g. appearance, navigation, communication, object interactions)Cognitive Activities Required prior to Simulation: [i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)]Read required corresponding readings (Taylor et al., 2011) (R )Review power point slide presentations (R,V)Review corresponding videos (V)Review assessment forms (R )Complete & pass Medication Calculations testSimulation Learning Objectives1. Psychomotor:The student will demonstrate proper procedure for preparing simulated medications.The student will demonstrate proper procedure for administration of oral medications.2. Cognitive:The student applies the concept of the 6 rights of medication administration to a simulated pt med pass.Fidelity (choose all that apply to this simulation)Setting/Environment:X Med-Surg UnitX Other: HospitalSimulator Manikin/s Needed: Virtual Simulation: Second Life Computers/laptops Headsets w/ microphonesProps: Virtual props: Bedside equipment: BP cuff, stethoscope, thermometer, walker, Incentive spirometerEquipment attached to manikin/virtual:XID band XOther: Allergy bandEquipment available in room/virtual:XIncentive SpirometerMedications and Fluids: N/ADiagnostics Available:X Labs: BS, PBCDocumentation Forms: X Physician OrdersX Flow sheetX Medication Administration RecordX KardexX Graphic RecordX Shift AssessmentX Code RecordX Anesthesia / PACU RecordX Other: Discharge ordersRecommended Mode for Simulation (i.e. manual, programmed, etc.)Synchronous Learning activity-Role assignments: Med/surgical nurse/student #1 Patient/Facilitator Nursing assistant/student #2 Instructor- observer clinical group- simulation performed in pairs Roles/Guidelines for Roles:X Primary NurseX Clinical Instructor/observerX Family Member #1X Observer/s (clinical instructor)X RecorderX Unlicensed Assistive Personnel/Nursing Assistant X Other: Patient/facilitator Important Information Related to Roles:Patient role- scripted responses for facilitator at times.Medication distractions- Pt. facilitator- scripted with distraction of request for BR, refusal of a med, & request for prn pain meds after regular med pass.Nursing assistant- scripted with distraction of family questions about meds during med pass & giving message of TC from ER for reportSignificant Lab Values:Glucose: 110PBC: WBC 8,000 H/H: 9.9/32Physician Orders:BRP w/ assistance w/ walker; 1800 cal ADA dietMedications:Persan 75mg po daily; Mylanta 10ml po qd, Lanoxin 0.125mg; PRN: Vicodin 1-2 tabs po q 4hrs.; pericolace prnAssessment data:BP: 122/78 HR: 92 RR: 18 Temp: 98.8Pain Score: 6 (0-10 scale)Student Information Needed Prior to Scenario:XHas been oriented to simulator/virtual environment XUnderstands guidelines /expectations for scenarioXHas accomplished all pre-simulation requirementsXAll participants understand their assigned rolesXOther: Testing of technology equipment/headphones w/ mic & computer connections for virtual environmentReport Students Will Receive Before Simulation:Time: 0745 post AM shift report.The scenario begins after the day shift report. During report, you are notified that you will receive an ER admission, too. Mr. Patterson is a 68 year old male who was admitted for a LTKA with PMH of chronic a-fib, gastric reflux, NIDDM. He is two days post op, and will be discharged home today with his wife. You have completed his assessment, and it is time to pass medications to Mr. Patterson, one of three patients you are currently assigned to today.References, Evidence-Based Practice Guidelines, Protocols, or Algorithms Used For This Scenario (site source, author, year, and page): AACN (American Association of College of Nursing). (2008). The Essentials of Baccalaureate Education for Professional Nursing Practice. Washington, DC.Aebersold, M. & Tschannen, D. (2012). Virtual reality simulations: Teaching interpersonal and clinical judgments skills to healthcare practitioners. In Maria Manuela Curz-Cunha (Ed.), Handbook of research on serious games as educational, business and research tools (Vol 1) (pp. 800-817). Hershey, PA: Information Science.Chang, Y. & Mark, B.A. (2009). Antecedents of severe and nonsevere medication errors. Journal of Nursing Scholarship, 41(1), 70-78.Cook, M.J. (2012). Design and initial evaluation of a virtual pediatric primary care clinic in Second Life. Journal of the American Academy of Nurse Practitioners, (24), 521-527.De Freitas, S. & Oliver, M. (2006). How can exploratory learning with games and simulations within the curriculum be most effectively evaluated? Computers & Education, 46(3), 249-264. Drach-Zahavy, A. & Pud, D. (2010). Learning mechanisms to limit medication administration errors. Journal of Advanced Nursing, 66(4), 794-805. doi: 10.1111/j.1365-2648.2010.05294.xIOM (Institute of Medicine). (2006). Preventing medication errors. Washington, DC: National Academy Press.Pape, T.M. Guerra, D.M., Muzquiz, M., Bryant, J.B., Ingram, M., Schranner, B., Alcala, A., Sharp, J., Bishop, D., Carreno, E., & Welker, J. (2005). Innovative approaches to reducing nurses’ distractions during medication administration. The Journal of Continuing Education in Nursing, 36(3), 108-116.QSEN (Quality and Safety Education for Nurses). (2013). QSEN competencies: Prelicensure KSAs. Retrieved from Progression OutlineTiming (approximate)Patient/Facilitator Second life ActionsNursing Assistant/Second life ActionsExpected InterventionsMay Use the Following CuesFirst 5-10 minutesWaiting for AM meds; Calls NA to ask for assistance to BRAssists with pt transfer/ ambulation to BRWash handsRemove meds from PyxisVerify expiration dateVerbalize med knowledgeVerbalize need for appropriate assessment dataCompare med label to MAR & places in cupVerbalizes 6 rts of med administrationRole member providing cue: Nursing AssistantCue: “I just assisted Mr. Patterson to the BR & he wants his AM meds.”Next 10-15 minutesRefuses to take pericolace; Asks questions about medications & requests pain meds.Phone rings & pt begins talking on it.Wife enters room asks questions about D/C plan today.Enters pt room to talk to RN during med pass to answer phone call.Introduces self to ptId’s pt in 2 ways & check allergies.Obtains appropriate assessmentsAnswers pt questions regarding meds or discusses resources to obtain med info if not known.Opens medications & gives to pt while verbalizing order of medsGives appropriate amount of fluids to drink.Asks pt to rate pain on scale.Verbalizes need for phone call to wait.Role member providing cue: Nursing AssistantCue: “The ER is on the phone & needs to call report to you”.Final 15-20 minutesPt calls for pain medication again.Answers pt’s call light for assistance.Positions pt safely & call light within reach.Documents medications accurately on MAR.Role member providing: Nursing assistantCue: “He asked for pain medication again”.Debriefing/Guided Reflection Questions for This SimulationWhat do you think well during this second life experience?What was occurring in the environment around the medication pass?What might the nurse have done differently?Clarifying the application of the 6 rights of medication administration in the situations.Reviewing the identification of the patient in 2 ways and the 3 medication check principle. Complexity – Simple to ComplexSuggestions for Changing the Complexity of This Scenario to Adapt to Different Levels of LearnersAdding additional patients.Increasing the complexity of the medication pass (e.g. adding parental meds, medications that require additional assessment data) ................
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