CREATE YOUR PEDIATRIC MOCK CODE PROGRAM Illinois Emergency

CREATE YOUR PEDIATRIC MOCK CODE PROGRAM Illinois Emergency Medical Services for Children is a collaborative program between the Illinois Department of Public Health and Loyola University Health System ILLINOIS EMSC 2012 1

WELCOME ILLINOIS EMSC 2012 2

ILLINOIS EMERGENCY MEDICAL SERVICES FOR CHILDREN (EMSC) 3 § Illinois EMSC is a collaborative program between the Illinois Department of Public Health and Loyola University Health System, aimed at improving pediatric emergency care within our state. § Since 1994, The Illinois EMSC Advisory Board and several committees, organizations and individuals within EMS and pediatric communities have worked to enhance and integrate § Pediatric education § Practice standards § Injury prevention § Data initiatives ILLINOIS EMSC 2012

CONFLICT OF INTEREST STATEMENT 4 This educational activity’s planners and the presenters have indicated they have no bias or conflict of interest. ILLINOIS EMSC 2012

5 CITATION INFORMATION This program was developed through federal grant funding. All training materials are considered under public domain and can be utilized by others in the conduction of similar educational programs, provided there is acknowledgement of the source of these materials. This slide set, and all related training materials, is in accordance with current practice at the time that this program was developed. Suggested Citation: Create Your Pediatric Mock Code Program, Illinois Emergency Medical Services for Children, March 2012. ILLINOIS EMSC 2012

AGENDA 6 1. Provide the background and history that led to this program offering 2. Develop strategies to respond to implementation barriers 3. Review the steps to pediatric mock code program creation 4. Incorporate facilitating and debriefing into pediatric mock codes (Exercise using three videotaped scenarios) 5. Maintain the gain 6. Wrap-up/Evaluation ILLINOIS EMSC 2012

7 “Chance favors the prepared mind. ” Louis Pasteur ILLINOIS EMSC 2012

OBJECTIVES 8 Develop strategies to respond to implementation barriers Review the steps to pediatric mock code program creation Incorporate facilitating and debriefing into pediatric mock codes ILLINOIS EMSC 2012

DEVELOP STRATEGIES TO RESPOND TO IMPLEMENTATION BARRIERS ILLINOIS EMSC 2012 9

10 DEVELOP STRATEGIES TO RESPOND TO IMPLEMENTATION BARRIERS Time Cost Unclear how to set up the program No one to coordinate the program Lack of Interest ILLINOIS EMSC 2012

11 DEVELOP STRATEGIES TO RESPOND TO IMPLEMENTATION BARRIERS Time Cost Unclear how to set up the program No one to coordinate the program Lack of Interest ILLINOIS EMSC 2012

12 DEVELOP STRATEGIES TO RESPOND TO IMPLEMENTATION BARRIERS Time Cost Unclear how to set up the program No one to coordinate the program Lack of Interest ILLINOIS EMSC 2012

13 DEVELOP STRATEGIES TO RESPOND TO IMPLEMENTATION BARRIERS Time Cost Unclear how to set up the program No one to coordinate the program Lack of Interest ILLINOIS EMSC 2012

14 DEVELOP STRATEGIES TO RESPOND TO IMPLEMENTATION BARRIERS Time Cost Unclear how to set up the program No one to coordinate the program Lack of Interest ILLINOIS EMSC 2012

15 DEVELOP STRATEGIES TO RESPOND TO IMPLEMENTATION BARRIERS Time Cost Unclear how to set up the program No one to coordinate the program Lack of Interest ILLINOIS EMSC 2012

REVIEW THE STEPS TO PEDIATRIC MOCK CODE PROGRAM CREATION ILLINOIS EMSC 2012 16

17 PEDIATRIC MOCK CODE PROGRAM VS. PERFORMING A SINGLE MOCK CODE Program Needs assessment information is applicable to future events Standard format builds predictability Decrease staff fears Practice over time builds competence and knowledge retention ILLINOIS EMSC 2012 Single mock code Same amount of pre-code preparation needed Effect of a one-time code is inadequate for knowledge retention No opportunity to trend progress over time

18 STEPS TO CREATE A PEDIATRIC MOCK CODE PROGRAM 1 • Solicit management support 2 • Recruit team members 3 • Conduct a needs assessment 4 • Create scenario elements 5 • Complete logistical planning 6 • Conduct an initial pilot mock code 7 • Hold the pediatric mock code 8 • Analyze data and report program results ILLINOIS EMSC 2012

19 STEP 1: SOLICIT MANAGEMENT SUPPORT Management Actions: ILLINOIS EMSC 2012 Support offering pediatric mock codes. Allow a needs assessment. Encourage other staff to participate.

NEXT STEPS 20 Step 3: Conduct a needs assessment Step 2: Recruit team members ILLINOIS EMSC 2012 Step 4: Create the forms Hold Mock Code Step 5: Complete the logistical planning Step 6: Conduct an initial pilot mock code

STEP 2: RECRUIT TEAM MEMBERS 21 TEAM COMPOSITION AND CHARACTERISTICS ILLINOIS EMSC 2012

STEP 2: RECRUIT TEAM MEMBERS 22 DISCUSS TIME COMMITMENT OPTIONS ILLINOIS EMSC 2012

23 STEP 3: CONDUCT A NEEDS ASSESSMENT Survey elements Staff fear and level of confidence with pediatric codes Staff experience with children Preferred day and time for mock codes Staff experience with pediatric codes Pediatric emergency topics for practice ILLINOIS EMSC 2012

24 STEP 4: CREATE SCENARIO ELEMENTS SCENARIO CREATION Design based on staff needs assessment and institutional preferences Create no more than 2 -3 goals and objectives for each scenario Keep in mind the skill level and experience of the learner ILLINOIS EMSC 2012

STEP 4: CREATE SCENARIO ELEMENTS SAMPLE CHALLENGES 25 Possible challenges: Inexperience with defibrillator Patient presents with an unstable airway ILLINOIS EMSC 2012

26 STEP 4: CREATE SCENARIO ELEMENTS SAMPLE CHALLENGE Inexperience with defibrillator ? ILLINOIS EMSC 2012

27 STEP 4: CREATE SCENARIO ELEMENTS CORRESPONDING OBJECTIVE Inexperience with defibrillator Safely utilize defibrillator ILLINOIS EMSC 2012

28 STEP 4: CREATE SCENARIO ELEMENTS SAMPLE CHALLENGE Patient presents with an unstable airway ? ILLINOIS EMSC 2012

STEP 4: CREATE SCENARIO ELEMENTS 29 CORRESPONDING OBJECTIVE Patient presents with an unstable airway Select correct size airway devices ILLINOIS EMSC 2012

STEP 4: CREATE SCENARIO ELEMENTS OBSERVER FORM 30 Decide on a mock code recording tool Current unit code review form Template from Pediatric Mock Code toolkit In-house version Videotaping ILLINOIS EMSC 2012

STEP 5: COMPLETE LOGISTICAL PLANNING 31 LOGISTICS CHECKLIST: § Schedule mock code § Arrange for a facilitator and an observer (if needed) § Reserve space § Determine equipment needed § Check equipment location § Confirm replacement process Photo is property of Illinois EMSC ILLINOIS EMSC 2012

STEP 5: COMPLETE LOGISTICAL PLANNING 32 LOGISTICS CHECKLIST (continued): § Simulated patient choices § Videotaping § Repetitive practice § Evaluation forms Photo is property of Illinois EMSC ILLINOIS EMSC 2012

33 STEP 6: CONDUCT AN INITIAL PILOT MOCK CODE ILLINOIS EMSC 2012

34 STEP 7: HOLD THE PEDIATRIC MOCK CODE ILLINOIS EMSC 2012

35 STEP 8: ANALYZE THE DATA AND REPORT PROGRAM RESULTS REPORT ELEMENTS: § Facilitator feedback § Lessons learned § Suggestions § Track progress from baseline § Celebrate improvements § Assure safety of the data § Provide confidentiality ILLINOIS EMSC 2012

STEPS TO CREATE A PEDIATRIC MOCK CODE PROGRAM 36 1 • Solicit management support 2 • Recruit team members 3 • Conduct a needs assessment 4 • Create scenario elements 5 • Complete logistical planning 6 • Conduct an initial pilot mock code 7 • Hold the pediatric mock code 8 • Analyze the data and report program results ILLINOIS EMSC 2012

37 Break time 10 minutes ILLINOIS EMSC 2012

INCORPORATING FACILITATING AND DEBRIEFING INTO PEDIATRIC MOCK CODES ILLINOIS EMSC 2012 38

WHY DEBRIEF? 39 To promote: reflection discussion learning ILLINOIS EMSC 2012

FACILITATORS CREATE A SAFE LEARNING ENVIRONMENT 40 Emphasize mutual respect Encourage team spirit and open expression by reaffirming common goals Seal the environment = “What happens here stays here!” ILLINOIS EMSC 2012

41 FACILITATOR MESSAGES TO MOCK CODE PARTICIPANTS Teamwork Encouraging Respectful Welcoming ILLINOIS EMSC 2012 Calm Participants Approachable

FACILITATOR ACTIONS 42 Before the Scenario Pre-brief elements Environment and equipment Introduce the scenario ILLINOIS EMSC 2012 (Training guide: Using simulation in Team. STEPPS Training, n. d. )

FACILITATOR ACTIONS 43 (CONTINUED) During the scenario Provide information keeping in mind the scenario goals and objectives Take notes on how it unfolds Identify performance gaps Identify debriefing points What went well What could be different, missing, awkward, etc. After the scenario Debrief the group ILLINOIS EMSC 2012 (Training guide: Using simulation in Team. STEPPS Training, n. d. )

DEBRIEF 44 Set the stage Arrange to encourage discussion Reemphasize safety Describe the expectations for debriefing State your objectives ILLINOIS EMSC 2012

DEBRIEFING DO’S 45 (Diane, Tsang & van Shaik, 2011) Acknowled ge and ask Emphasize and explore ILLINOIS EMSC 2012 Demonstrat e objective observance s Do. . Build, beliefs and barriers Correct and collaborate

DEBRIEFING DO’S 46 (Diane, Tsang & van Shaik, 2011) Acknowledg e and ask Emphasize and explore ILLINOIS EMSC 2012 Demonstrat e objective observance s Do. . Build, beliefs and barriers Correct and collaborate

DEBRIEFING DO’S 47 (Diane, Tsang & van Shaik, 2011) Acknowledg e and ask Emphasize and explore ILLINOIS EMSC 2012 Demonstrat e objective observance s Do. . Build, beliefs and barriers Correct and collaborate

DEBRIEFING DO’S 48 (Diane, Tsang & van Shaik, 2011) Acknowledg e and ask Emphasize and explore ILLINOIS EMSC 2012 Demonstrat e objective observance s Do. . Build, beliefs and barriers Correct and collaborate

DEBRIEFING DO’S 49 (Diane, Tsang & van Shaik, 2011) Acknowledg e and ask Emphasize and explore ILLINOIS EMSC 2012 Demonstrat e objective observance s Do. . Build, beliefs and barriers Correct and collaborate

DEBRIEFING DON’TS 50 Accuse Sugar coat Blame Criticize ILLINOIS EMSC 2012

3 PHASES OF DEBRIEFING 51 Description Phase Analysis Phase Application/Generalization Phase ILLINOIS EMSC 2012 (Training guide: Using simulation in Team. STEPPS Training, n. d. )

3 PHASES OF DEBRIEFING: 52 DESCRIPTION PHASE Start by asking them to describe what emotions they are feeling Recap the scenario Have one person do a brief one to two sentence summary and others can add or subtract Team members share their perspectives on what happened so everyone is on the ‘same page’ ILLINOIS EMSC 2012 (Training guide: Using simulation in Team. STEPPS Training, n. d. )

53 3 PHASES OF DEBRIEFING: ANALYSIS PHASE What went well? Yourself Saw in others What didn’t go well? Yourself Team behavior What would you do differently next time? Yourself ILLINOIS EMSC 2012 With others (Training guide: Using simulation in Team. STEPPS Training, n. d. )

3 PHASES OF DEBRIEFING: APPLICATION/GENERALIZATION PHASE 54 Team members describe lessons learned Changes in practice Changes in policy Changes in procedures ILLINOIS EMSC 2012 (Training guide: Using simulation in Team. STEPPS Training, n. d. )

IN SUMMARY… 55 Debrief to promote reflection, discussion, and learning Create a safe environment Incorporate “Do’s” when facilitating a debriefing and avoid debriefing “Don’ts” Use the 3 phases of debriefing as guidance to allow conversation to flow Refer back to your scenario goal, challenges and objectives to help focus the debriefing session ILLINOIS EMSC 2012

DISCLAIMER 56 The contents of the following video are fictionalized. All medical personnel appearing in the scenarios are acting out assigned roles. Any resemblance to real events and people, living or deceased, is entirely coincidental. The following video was filmed in a high fidelity simulation setting. It is important to understand that this level of technology is not necessary in order to perform an effective pediatric mock code. ILLINOIS EMSC 2012

57 VIDEO FACILITATING AND DEBRIEFING Case #1 This is an example of a scenario and debriefing from A to Z Click Here ILLINOIS EMSC 2012

58 Break time 10 minutes ILLINOIS EMSC 2012

INCORPORATING FACILITATING AND DEBRIEFING 59 Case #2 Click Here ILLINOIS EMSC 2012

INCORPORATING FACILITATING AND DEBRIEFING 60 Case #3 Click Here ILLINOIS EMSC 2012

GREAT JOB! 61 ILLINOIS EMSC 2012

MAINTAIN THE GAIN 62 Complete pre-code needs assessment, logistics, scenario and evaluation creation Analyze feedback and report suggestions to staff and management Hold the pediatric mock code Evaluate feedback from participants and program members ILLINOIS EMSC 2012

RESOURCES 63 Resources available to you and your program Mock code video scenarios Pediatric Mock Code Toolkit Train-the-Trainer Power. Point Presentation All resources are available online at www. luhs. org/emsc ILLINOIS EMSC 2012

REFERENCES 64 1. Topjian AA, Berg RA, Nadkarni VM. Pediatric cardiopulmonary resuscitation: Advances in science, techniques, and outcomes. Pediatrics. 2008 Nov; 122(5): 1086 -98. 2. Andreatta P, Saxton E, Thompson M, Annich G. Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates. PEDIATR CRIT CARE MED. 2011; 12(1): 33 -8. 3. von Arx D, Pretzlaff R. Improved nurse readiness through pediatric mock code training. J Pediatr Nurs. 2010 10; 25(5): 438 -40. 4. Hunt EA, Hohenhaus SM, Luo X, Frush KS. Simulation of pediatric trauma stabilization in 35 North Carolina emergency departments: Identification of targets for performance improvement. Pediatrics. 2006 03; 117(3): 641 -8. 5. Mancini ME, Soar J, Bhanji F, Billi JE, Dennett J, Finn J, et al. Part 12: Education, implementation, and teams: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2010 Oct 19; 122(16 Suppl 2): S 539 -81. ILLINOIS EMSC 2012

REFERENCES 65 6. Mikrogianakis A, Osmond MH, Nuth JE, Shephard A, Gaboury I, Jabbour M. Evaluation of a multidisciplinary pediatric mock trauma code educational initiative: A pilot study. J Trauma. 2008 Mar; 64(3): 761 -7. 7. van Schaik SM, Plant J, Diane S, Tsang L, O'Sullivan P. Interprofessional team training in pediatric resuscitation: A low-cost, in situ simulation program that enhances self-efficacy among participants. Clin Pediatr (Phila). 2011 Sep; 50(9): 807 -15. 8. Mann K, van der Vleuten C, Eva K, Armson H, Chesluk B, Dornan T, et al. Tensions in informed self-assessment: How the desire for feedback and reticence to collect and use it can conflict. Acad Med. 2011 Sep; 86(9): 1120 -7. 9. Auerbach M, Kessler D, Foltin JC. Repetitive pediatric simulation resuscitation training. Pediatr Emerg. 2011 Jan; 27(1): 29 -31. ILLINOIS EMSC 2012

REFERENCES 66 10. Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthcare. 2007 Summer; 2(2): 115 -25. 11. Beaubien JM, Baker DP. The use of simulation for training teamwork skills in health care: How low can you go? Qual Saf Health Care. 2004 Oct; 13 Suppl 1: i 51 -6. 12. Training Guide: Using Simulation in Team. STEPPS Training retrieved 1. 2012 from Link: http: //www. ahrq. gov/teamsteppstools/simulation/index. html 13. Diane S. , Tsang L, van Shaik, S. UCSF Children’s Hospital Mock Code Training Power. Point 2011 by the Regents of the University of California. Used with permission. 14. Rudolph JW, Simon R, Rivard P, Dufresne RL, Raemer DB Debriefing with Good Judgment: Combining Rigorous Feedback with Genuine Inquiry. Anesthesiology Clin 2007 June; 25(2): 361– 376. ILLINOIS EMSC 2012

THANKS! "There are risks and costs to a program of action. But they are far less than the long-range risks and costs of comfortable inaction. " John F. Kennedy ILLINOIS EMSC 2012 67