Medical Error Simulation

Montgomery College Nursing Simulation Scenario Library Scenario File: Medical Error Discipline: Nursing Expected Simulation Run Time: 20 min Admission Date: today Time: 2215 Brief Description of Client: Name: Roger Waters Gender: M Age: 65 Race: caucasian Weight: 85kg Height: 177cm Student Level: advanced Guided Reflection Time: 40 min Psychomotor Skills Required Prior to Simulation patient assessment SBAR/handoff Oral medication administration Application of rapid response/first aid guidelines Patient safety and communication skills Religion: n/a Major Support: son, lives 200 miles away Allergies: fluoroquinolones Immunizations: up to date Attending Physician/Team: Youngblood Past Medical History: HTN, CAD, Atrial fibrillation, high cholesterol Cognitive Activities Required Prior to Simulation [i.e. independent reading (R), History of Present illness: Admitted after he became dizzy at home and fell. He has a laceration on the left arm wrapped in a kerlix dressing with no apparent bleeding. Vital signs in the ED two hours ago were BP-136/84, HR 92, R 20, T 98 Scenario: Medical Error video review (V), computer simulations (CS), lecture (L)] Review actions, side effects, correct dosage, nursing considerations for norvasc, Lipitor and warfarin. (R) Review focussed assessment guidelines. (R) View “Preventing Medication Errors” dvd prior to simulation. (optional)(V) Page 1 Montgomery College Nursing Simulation Scenario Library Social History: Lives alone, divorced, retired musician, quit smoking several years ago, occasional ETOH Primary Medical Diagnosis: syncope Surgeries/Procedures & Dates: no psh Nursing Diagnosis: Collaborative Problems: Simulation Learning Objectives 1. Safely administer medications by avoiding errors that have high potential for serious patient harm. 2. Identify rationales for holding certain medications in a given patient and appropriate follow up for the given situation. 3. Recognize an acute deterioration in patient condition. 4. Manage the initial phase of an acute reaction to a medication that was administered. 5. Identify the primary nursing diagnosis and/or collaborative problems. 6. Document the assessments, patient changes, and interventions completed. 7. Demonstrate therapeutic communications in care of the patient and family. Fidelity (choose all that apply to this simulation) Setting/Environment Medications and Fluids o X o o o o o o o o ER Med Surg Peds ICU OR / PACU Women’s Center Behavioral Health Home Health Pre-Hospital Other _________________ Simulator/Manikin/s Needed: Standardized patient or high fidelity mannequin Scenario: Medical Error X Oral Meds ○ IV Fluids ○ IVPB ○ IV Push ○ IM / Subcut / Intradermal ○ Other Page 2 Montgomery College Nursing Simulation Scenario Library Props: Equipment Attached to Manikin: Diagnostics Available o o o o X-rays (Images) Labs 12-Lead EKG Other__________________ °IV tubing with primary line fluids running at cc/hr o Secondary IV line __ running at _ cc/hr o IV pump o Foley catheter ________cc output Documentation Forms o PCA pump running X Admit Orders o IVPB with ___ running at ___ cc/hr o Physician Orders o 02 _______ o Flow sheet o Monitor attached X Medication Administration Record X ID band o Kardex X Other- saline lock attached to R arm and o Graphic Record kerlix dressing on L arm, blood moulage if o Shift Assessment RN gives warfarin before drawing labs o Triage Forms o Code Record Equipment Available in Room o Anesthesia / PACU Record o Bedpan/Urinal o Standing (Protocol) Orders o Foley kit o Transfer Orders o Straight Cath Kit o Other o Incentive Spirometry o Fluids o IV start kit o IV tubing o IVPB Tubing o IV Pump o Feeding Pump Recommended Mode for Simulation o Pressure Bag (i.e. manual, programmed, etc.) o 02 delivery device_______________ o Crash cart with airway devices and emergency medications o Defibrillator/Pacer o Suction X Other – dynamap, extra towels, exam gloves, cup, straw, water pitcher, computer for documentation Scenario: Medical Error High fidelity or with standardized patient Page 3 Montgomery College Nursing Simulation Scenario Library Roles/Guidelines for Roles X Primary Nurse X Secondary Nurse X Transferring Nurse o Family Member #1 o Family Member #2 X Observers X Physician / Advanced Practice Nurse o Respiratory Therapy o Anesthesia o Pharmacy o Lab o Imaging o Social Services o Clergy o Unlicensed Assistive Personnel o Code Team X Other- MD and unit secretary can be “voice only” roles Important Information Related to Roles: Patient can be a standardized patient or high fidelity simulator. Person running the simulation can also be the voice of the MD and unit secretary, or those roles can be given to observers. Significant Lab Values- labs have not yet been drawn Physician Orders – see separate attachment Scenario: Medical Error Page 4 Montgomery College Nursing Simulation Scenario Library References, Evidence-Based Practice Guidelines, Protocols, or Algorithms Used For This Scenario: (site source, author, year, and page) Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., O’Brien, P.G &Bucher, L. (2007). Medical surgical nursing (7th ed.). St. Louis, Mosby Elsevier. Turkoski, B.B., Lance, B.R. & Bonfiglio, M.F. (2007). Drug information handbook for advanced practice nursing (8th ed.). Hudson, Lexi-Comp. Scenario: Medical Error Page 5 Montgomery College Nursing Simulation Scenario Library 2007 NCLEX-RN© Test Plan Categories and Subcategories Choose all areas included in the simulation Safe and Effective Care Environment Management of Care ● ● ● ● ● ● ● ● ● ● Advance Directives Advocacy Case Management Client Rights Collaboration with Interdisciplinary Team Concepts of Management Confidentiality / Information Security Consultation Continuity of Care Delegation Safety and Infection Control ● ● ● ● ● ● ● ● Accident Prevention Disaster Planning Emergency Response Plan Ergonomic Response Plan Error Prevention Handling Hazardous and Infectious Materials Home Safety Injury Prevention Health Promotion and Maintenance ● ● ● ● ● ● ● ● ● Aging Process Ante/Intra/Postpartum and Newborn Care Developmental Stages and Transitions Disease Prevention Expected Body Image Changes Family Planning Family Systems Growth and Development Health and Wellness Psychosocial Integrity ● ● ● ● ● ● ● Abuse/Neglect Behavioral Interventions Chemical and Other Dependencies Coping Mechanisms Crisis Intervention Cultural Diversity End of Life Care Scenario: Medical Error ● ● ● ● ● ● ● ● ● ● Establishing Priorities Ethical Practice Informed Consent Information Technology Legal Rights and Responsibilities Performance Improvement (QI) Referrals Resource Management Staff Education Supervision ● ● ● ● Medical and Surgical Asepsis Reporting of Incident/Event/ Irregular Occurrence/Variance Security Plan Standard /Transmission-Based / Other Precautions Use of Restraints/Safety Devices Safe Use of Equipment ● ● ● ● ● ● ● ● ● Health Promotion Programs Health Screening High Risk Behaviors Human Sexuality Immunizations Lifestyle Choices Principles of Teaching/Learning Self-Care Techniques of Physical Assessment ● ● Psychopathology Religious and Spiritual Influences on Health Sensory/Perceptual Alterations Situational Role Changes Stress Management Support Systems ● ● ● ● ● ● Page 6 Montgomery College Nursing Simulation Scenario Library ● ● ● Family Dynamics Grief and Loss Mental Health Concepts ● ● ● Therapeutic Communications Therapeutic Environment Unexpected Body Image Changes ● ● ● ● Nutrition and Oral Hydration Palliative/Comfort Care Personal Hygiene Rest and Sleep ● ● ● ● ● Parenteral/Intravenous Therapies Pharmacological Agents/Actions Pharmacological Interactions Pharmacological Pain Management Total Parenteral Nutrition ● ● ● ● Potential for Complications from Surgical Procedures and Health Alterations System Specific Assessments Therapeutic Procedures Vital Signs ● ● ● ● Medical Emergencies Pathophysiology Radiation Therapy Unexpected Response to Therapies Physiologic Integrity Basic Care and Comfort ● ● ● ● ● Assistive Devices Complementary and Alternative Therapies Elimination Mobility/Immobility Non-Pharmacological Comfort Interventions Pharmacological and Parenteral Therapies ● ● ● ● ● ● Adverse Effects/Contraindications Blood and Blood Products Central Venous Access Devices Dosage Calculation Expected Effects/Outcomes Medication Administration Reduction of Risk Potential ● ● ● ● ● Diagnostic Tests Lab Values Monitoring Conscious Sedation Potential for Alterations in Body Systems Potential for Complications of Diagnostic Tests/Treatments/Procedures Physiologic Adaptation ● ● ● ● ● Alterations in Body Systems Fluid and Electrolyte Imbalances Hemodynamics Illness Management Infectious Diseases Scenario: Medical Error Page 7 Montgomery College Nursing Simulation Scenario Library Scenario Progression Outline Timing (approximate) First 5 minutes Manikin Actions Patient is tired, irritable, just wants to sleep. BP is 160/90, HR 96, RR 18 and temp 98, pulse ox is 97% and pain level is 0. L arm dressing is without drainage, intact. Saline lock in R arm is WNL. Pt continues to ask for meds, milk, crackers Expected Interventions Primary RN takes report and begins assessment. Role members providing cue: Transferring RN, patient Cues: report to primary RN, Patient wants RN to finish quickly, wants to take his meds so he can sleep. He is concerned about his blood pressure, and taking meds at the same time every day. RN finishes assessment, checks Role member orders, administers appropriate providing cue: medications patient, unit secretary Next 5-10 minutes Scenario ends if RN holds warfarin until after lab results are available. If all three meds are given, she is called out of the room to help settle another admission while patient is moulaged. Scenario: Medical Error May Use the Following Cues Cue: “I need those medications now!” (pt) “lab labels are up for Mr. Waters” and “your new admission is here in 345” Page 8 Montgomery College Nursing Simulation Scenario Library Final 15-20 minutes Pt upset by sight of his own blood. BP is 118/76, T 98, HR 118, R 20, pulse ox 93%, too upset to rate pain, if asked RN returns to room to draw labs, calls for help, cares for pt, provides SBAR to MD Role member providing cue: patient Cue: “Do something! Get some help!” Debriefing / Guided Reflection Questions for this Simulation (Remember to identify important concepts or curricular threads that are specific to your program) 1. How did you feel throughout the simulation experience? 2. Describe the objectives you were able to achieve? 3. Which ones were you unable to achieve (if any)? 4. Did you have the knowledge and skills to meet objectives? 5. Were you satisfied with your ability to work through the simulation? 6. To Observer: Could the nurses have handled any aspects of the simulation differently? 7. If you were able to do this again, how could you have handled the situation differently? 8. What did the group do well? 9. What did the team feel was the primary nursing diagnosis and/or collaborative problems? 10. What were the key assessments and interventions? 11. Is there anything else you would like to discuss? Scenario: Medical Error Page 9 Montgomery College Nursing Simulation Scenario Library Scenario Specific Questions: Program/Curricular Specific Questions: Complexity – Simple to Complex Suggestions for changing the complexity of this scenario to adapt to different levels of learners: ● ● ● Scenario: Medical Error Page 10