Scenario Planning Template - Iv start kits with catheters

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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? | | |

| | | | |

| |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? | | |

| | | | |

| |Or, individually: Let’s go around and have each of you describe your main take-home | | |

| |message from the scenario. | | |

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