IH - UBC Simulation Program Annual Report 2017 - 2018

Interior Health/UBC Faculty of Medicine Simulation Program 2017-18 Annual Report

Table of Contents Executive Summary .................................................................................4 Vision & Mission Statement ....................................................................5 Staff ...........................................................................................................6 Donors.......................................................................................................8 Metrics.......................................................................................................9 Utilization – Fixed Centres .................................................................................................................... 9 Evaluation Data – Fixed Centres ............................................................................................................. 10 Attendance – Rural Sites ........................................................................................................................ 11 Evaluation Data – Rural Sites ................................................................................................................. 12

Simulation Educational Courses ..........................................................13 Research .................................................................................................15 Notable Achievements...........................................................................16 Publication - two part series on Simulation ............................................................................................... 16 Simulation Fellowship ............................................................................................................................ 16 Emergency Nursing Association of BC Conference (ENABC) ..................................................................... 17 Simulated Ultrasound Machine ............................................................................................................... 17

Professional Development ....................................................................18 Simulation Learning Strategies ............................................................................................................... 18 Royal College of Canada Simulation Summit ........................................................................................... 18 Preventative Maintenance (PM) Course ................................................................................................... 18 Gateway Debriefing Skills Workshop ....................................................................................................... 19

Education ................................................................................................23 UBC Faculty of Medicine – Southern Medical Program .......................................................................... 23 Transition into Clinical Education (TICE) ............................................................................................. 23 UBC Faculty of Medicine – Family Medicine ........................................................................................... 24 Canadian Residency Simulation Tournament (CReST) ................................................................... 24 UBC FoM Family Practice (FP) Residency Programs ...................................................................... 24

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Kelowna Emergency Medicine Residency Program................................................................................ 25 The UBC Emergency Medicine Interior Site ........................................................................................ 25 Emergency Department (ED) in situ .................................................................................................... 25 Interior Health ......................................................................................................................................... 26 Safe Consumption Site ....................................................................................................................... 26 The BC Society of Respiratory Therapists (BCSRT) ........................................................................... 26 Mock Code Pinks ................................................................................................................................ 27 Five Alive Blue and White ................................................................................................................... 27 Just in Time ........................................................................................................................................ 27 IH Rural Mobile Simulation Program ....................................................................................................... 29

Collaboration Provincially .....................................................................30 Mobile Medical Unit (MMU) .................................................................................................................... 30 Simulation Trauma Update Course (STRUC) ......................................................................................... 30

Provincial Initiatives ..............................................................................31 The British Columbia Simulation Network (BCSN) .................................................................................. 31 Clinical Simulation Management System ................................................................................................ 31 Capital Equipment Purchase Contract .................................................................................................... 31

Collaboration with Schools ...................................................................32 UBC Okanagan School of Nursing ......................................................................................................... 32 British Columbia Institute of Technology (BCIT) Emergency Nursing...................................................... 32 University of Northern BC(UNBC) Rural Emergency Nursing Course ..................................................... 32 Thompson River’s University (TRU) Respiratory Therapy (RT) Program ................................................ 32 Selkirk College Nursing Program ............................................................................................................ 33 School District #23.................................................................................................................................. 33 Justice Institute of British Columbia (JIBC) ............................................................................................. 33

Moulage...................................................................................................35 Upcoming in 2018-19 .............................................................................36

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Executive Summary Interior Health, the University of British Columbia (UBC) Faculty of Medicine (FoM), and University of British Columbia Okanagan School of Nursing have formed a partnership to work collaboratively in order to provide simulation education activities for undergraduate, postgraduate, practicing clinicians and physicians across UBC and Interior Health (IH).

Fiscal Year 2017-18 saw tremendous growth with the simulation programs across all sites in Interior Health. We endeavored to undertake research in our rural emergency sites, a simulation fellowship at Kelowna General Hospital, publications, hosting of provincial conferences, collaboration with various schools from inter-professional to specialty training, undergrad and postgrad curriculum based simulation, as well as various mock codes exercises on patient floors. We opened the third simulation site in Interior Health which will serve the west and east Kootenay’s. The Rae Fawcett Simulation Centre in Kamloops has been operational for three years; they saw a 157 percent increase in utilization from 2016 to 2017. This year also marks five years for the Pritchard Simulation Centre. We’ve come a long way from training mostly practicing nurses in Cardiac Arrest Management to now offering courses that include simulation for advanced life support, resuscitation, clinical competency, specialty training, as well as undergrad and postgrad training.

With the increased use of simulation training in medical school, residency, and hospitals alike, we endeavor to meet the growing needs of all learners. The IH/UBC FoM Simulation Program management and staff will continue to work collaboratively with our partners to provide education and training that supports high quality and safe care for our patients.

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Vision & Mission Statement

Vision To support excellence in healthcare delivery through the use of simulation based education.

Mission To facilitate simulation-based education that:  promotes inter-professional engagement and collaboration; and  supports highly competent providers to achieve excellence in health care delivery

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Staff Pritchard Simulation Centre JoAnne Slinn, RN, MN, ENC (C) Regional Knowledge Coordinator JoAnne is a Registered Nurse, with a background in emergency nursing and the Regional Knowledge Coordinator (RKC) or educator at the Pritchard Simulation Centre, located at KGH/UBC Clinical Academic Campus. JoAnne recently completed her Masters of Nursing and has CNA certification in emergency nursing. JoAnne started her role as the RKC in 2015.

Chris Olivier Simulation Technician Chris Olivier is the Simulation Technician for the Pritchard Simulation Centre, Rae Fawcett Simulation Centre, the KB Simulation Program and the UBC Okanagan School of Nursing.

Chris has shown keen interest in simulation as has been integral in designing simulation centre’s across our region, building simulated ultrasound machines while creating new and innovated modalities to meet the needs of our simulation community.

Rae Fawcett Simulation Centre Chelsea Holmes, RN, BSN, ENC (C) Regional Knowledge Coordinator Chelsea Holmes is a Registered Nurse, with a background in emergency nursing and the Regional Knowledge Coordinator (RKC) or educator at the Rae Fawcett Simulation Centre at Royal Inland Hospital in Kamloops, B.C. Chelsea has been facilitating with the IH Rural Mobile Simulation Program since 2013 and started her role as the RKC in 2016.

Kootenay Boundary (KB) Simulation Program Helen Clugston, RN, BSN Regional Knowledge Coordinator Helen Clugston is a Registered Nurse with a background in emergency, pediatrics and rural nursing. She is the Regional Knowledge Coordinator (RKC) or educator at the KB Simulation Program at Kootenay Boundary Regional Hospital in Trail, B.C. Helen has been facilitating with the IH Rural Mobile Simulation Program since 2013 and started her role as the RKC in 2016.

Helen is passionate about supporting others to be the best that they can be through creative, supportive and realistic learning opportunities using simulation technologies.

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Staff IH Simulation Program Dr. Tara Gill, MD, CCFP-EM Medical Director, IH Rural Mobile Simulation Program Dr. Gill is an emergency physician and rotation lead for the integrated community clerkship (ICC) program in Trail. Dr. Gill provides leadership and instruction in simulation education, training and research to improve the quality of healthcare and improve patient safety outcomes.

Shelly Koochin Simulation Coordinator Shelly brought her 15 years of project management experience to develop and grow the simulation program in Interior Health.

Shelly provided her vision and expertise to assist in building staff, resources and simulation centres across the Health Authority, in order to create more opportunity and access for this specialized education.

Ben Rhebergen Director, Strategic Initiatives-Acute & Medical School Ben oversees the Simulation Program across Interior Health to ensure that staff are supported in order to provide the best possible simulation education activities.

Lisa Wyness Director of Administration, Faculty of Medicine, Southern Medical Program (SMP) Lisa works with the staff and faculty across the SMP sites in Kelowna, Vernon, Kamloops and Trail as well as the Faculty of Medicine (FoM) distributed sites to ensure the successful delivery of the FoM Doctor of Medicine (MD) Undergraduate Program in the Interior.

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Donors The University of British Columbia (UBC) Faculty of Medicine (FoM) has been very fortunate to receive donations from Lois and Colin Pritchard. Without the Pritchard’s generous donations towards the first simulation centre built in Kelowna and the purchase of high fidelity human patient simulators, we would not be where we are today! Thank you.

Pritchard Simulation Centre 2011

Lois and Colin Pritchard for UBC FoM

2015 2018

Lois and Colin Pritchard for UBC FoM Lois and Colin Pritchard for UBC FoM

SimMan3G (Laerdal) Harvey Simulator (Laerdal) Infrastructure SonoSite EDGE Ultrasound System (2) SuperTory Neonate (Gaumard)

Rae Fawcett generously donated towards high fidelity human patient simulators in Kamloops where simulation also serves Interior Health clinicians, UBC faculty, students and residents. Thank you.

Rae Fawcett Simulation Centre 2015 2015 2015 2018

Rae Fawcett for Interior Health Rae Fawcett for Interior Health Rae Fawcett for Interior Health Rae Fawcett for Interior Health

SimMan3G & SimJunior Victoria Birthing Simulator (Gaumard) SonoSite EDGE Ultrasound System SuperTory Neonate (Gaumard)

The various Foundations donated towards a high fidelity human patient simulator that serves the rural hospital sites across Interior Health. Thank you.

IH Rural Mobile Simulation Program 2016

For Interior Health:  KGH Foundation  RIH Foundation  KLH Foundation  PRH Foundation  EKH Foundation  VJH Foundation

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SimMan3G (Laerdal)

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Metrics U t i l i z a t i o n – F i xe d C e n t r e s Simulation education has increased across all sites and professions in Interior Health and UBC FoM. This graph displays the utilization (hours) that we saw when the Pritchard Simulation Centre opened in 2013, the growth in 2016 with the addition of the Rae Fawcett Simulation Centre and finally the growth in 2017 that included the addition of the Kootenay Boundary Simulation Program.

Utilization Data for Fixed Sites Pritchard Simulation Centre Rae Fawcett Simulation Centre Kootenay Boundary Simulation Program Total Utilization

2500

1916

2000

1500 1194.5

1000

776.35

855.25

677.23 689.65

676.23 500

980 868

312.02 337.25

312.02

68

54.5

0 2013

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2014

2015

2016

2017

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Metrics Evaluation Data – Fixed Centres Questions The outlined learning objectives were met This session content enhanced my knowledge I was able to incorporate theory into hands-on practice I feel more confident in patient management This simulation encouraged me to think critically I believe this session will help me improve patient outcomes The debrief was valuable I would like to continue to use this technology in future education The facilitator(s) maintained an engaging context for learning The facilitator(s) fostered a safe learning environment

Global Average (/5) 4.75 4.82 4.73 4.52 4.71 4.68 4.67 4.78 4.84 4.85

Open Ended Questions – comments taken from a few participants List two (2) strong strengths of the simulation session  Able to pause and discuss during the sim, getting practice on a pediatric patient. I like the pictures on screen to show what the patient looks like.  Practice of different roles during different scenarios without consequence of real death. Debrief was valuable with take away points.  Communication and being able to learn in a safe environment.  It’s great to put theory into practice in a safe environment. I learn best with hands on experience.

List two (2) things you'd like to see done differently  Maybe a bit more time with peds review prior to sim. Or a hysterical mom in the sim.  I would like a younger child as well as the older child, just to feel more confident with pediatrics as a whole. Also, a pregnant trauma.  I appreciated the small group. It was great learning from each other.  Time to actually do whole procedure such as complete prep and admin of octeplex. Time to re-practice what we learned, i.e. octeplex mixing.

Any other comments?  Great learning experience and helped to solidify some take away points.  The sims make me feel more confident in my knowledge.  Enjoyed the discussion and learning with each scenario. Non-threatening environment - fostered better learning.  This course was done well, small group made the greatest difference (large group would have been difficult.

Good Story Family Medicine residents in Kelowna have been participating in simulation sessions since the start of our residency. These sessions have been very helpful in dealing with critical care situations on the wards, thus making us much more confident in managing unexpected situations during our first few months of residency. At one of the simulation sessions, we reviewed the management of accidental hypothermia’s. A few days later, a patient presented to the emergency room with a cardiac arrest related to an accidental hypothermia. Due to the knowledge acquired in the simulation session, we were able to optimize the rewarming of our patient and activate our ECMO team early in the resuscitation. “Simulation based learning which included reviewing the most recent guidelines on accidental hypothermia definitely improved the care provided in this situation”.

Family Medicine Resident, UBC FoM Kelowna site

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Metrics Attendance – Rural Sites In 2017-18, facilitators travelled to 20 rural hospital sites, sometimes visiting a site twice in the year. 241 participants attended sessions throughout the region in the spring and fall.

NB: Facilitators do not travel in summer or winter.

Map of rural sites visited in 2017

These educational sessions are attended by an inter-professional group of clinicians that vary from site to site. We usually see the highest attendance in nursing, followed by physicians and paramedics.

Percent of Attendance by Discipline

Attendance LPN 4% Paramedic 14%

RN 43%

MD 33%

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RN MD Paramedic LPN Admin Medical Student - Year 1 Medical Student NP Lab Technician Medical Student - Year 3 MLA NP Student Resident RN Student

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Metrics Evaluation Data – Rural Sites Questions The outlined learning objectives were met This program content enhanced my knowledge My knowledge in assessment of patients improved I was able to incorporate theory into hands-on practice I developed a better understanding of the medications, equipment, and supplies used in practice I believe this session will help me improve patient outcomes The presentations offered balanced views This session was free from bias (e.g., conflict of interest, promotional content, product endorsement) The facilitator(s) maintained an engaging context for learning The facilitator(s) guided discussions that led me to reflect on my practice The facilitator(s) fostered a safe learning environment

Global Average (/5) 4.72 4.78 4.48 4.65 4.60 4.76 4.78 4.89 4.87 4.83 4.89

Open Ended Questions – comments taken from a few participants Reflecting on today's session, I am motivated to integrate into/change my practice in the following ways  Review machines more often. Consider options earlier in treatment.  Protocols available in other departments such as DKA. Stronger communication on arrival at ER  Identifying team lead. Waiting to report, until team gathered / appropriate time.  Use of emergent equipment & medications, as well as using & implementing algorithms.  Be a little more vocal/assertive in my role as RN. Use the closed-loop more effectively.

List two (2) strengths of the simulation session  Feel like a part of the team and getting to know physicians better.  Brought up discussions about best treatment. Encouraged team communication.  Lots of reflection on own practice. Involvement of paramedics to hear their views.  Great, realistic scenarios with opportunity to practice management of acutely ill patients. Opportunity to debrief/reflect on own performance and team work. Fantastic session! Thanks!  Super hands on and high fidelity. Safe learning/ discussion for whole team.  Great team environment. Identify gaps in equipment & stocked in ED trauma bay.  I felt free to ask questions without judgement. Interventions and medications were properly explained to me.

Can you identify any barriers to incorporating what you learned today into your practice? (e.g., knowledge, attitude, behavioural, organizational)  Knowing where equipment is - Better now that we have had sim session  My own lack of knowledge of Peds chart  The usual possible lack of staff (RNs and specialists). Transferring pts to higher levels of care.  Lack of exposure, i.e. may be a long time before I am exposed to this again in the ER.  Not seeing a lot of trauma cases in our emerg; Not too many staff to help during resuscitations.  Not having enough exposure in day to day work.

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Simulation Educational Courses The Simulation Programs across the Health Authority offers educational courses that include simulation. These courses are: 

Advanced Trauma Life Support (ATLS)

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Advanced Cardiac Life Support (ACLS)

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Basic Life Support (BLS)

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Pediatric Advanced Life Support (PALS)

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Neonatal Resuscitation Program (NRP)

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MOREob Skills Drills

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Essentials of Critical Care Orientation (ECCO)

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Emergency Practice, Interventions and Care Canada (EPICC)

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Trauma Nursing Core Course (TNCC)

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Mock codes

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In situ – simulation on various units

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Nursing clinical competency simulation sessions

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Nursing specialty training

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Physician specialty training

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Respiratory Therapy simulation sessions

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Outreach simulation training

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Preventing Alcohol and Risk-related Trauma in Youth (PARTY)

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UBC Faculty of Medicine under-grad and post-grad simulation training

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Simulation Educational Courses Outreach Simulation Education The Mobile Medical Unit (MMU) and the IH Simulation Program collaborated to carry out emergency and disaster scenarios at Elk Valley Hospital in Fernie.

Facilitator Training Our simulation facilitators gather together annually to share key learning, discuss advancement in simulation, and share best practices. This session was held at the Pritchard Simulation Centre in Kelowna.

Student Orientation Students from the Stswecem’c Xgat’tem First Nations, interested in pursuing a career in healthcare are provided with an orientation at the Rae Fawcett Simulation Centre.

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Research D o e s s i m u l a t i o n e n h a n c e k n o wl e d g e a n d a p p r e c i a t i o n o f I n t e r i o r Health Pre-Printed Orders (PPO)? 



Interior Health (IH) Simulation Program completed a research project in 2017. Research Question: Does simulation enhance knowledge and appreciation of Interior Health Pre-Printed Orders (PPO)?

A severe adult asthma simulation scenario was designed based on the IH Asthma: Severe Adult Emergency Department PPO.

Results showed substantial improvements in comfort levels in using the PPO, increased knowledge of the PPO, and improved confidence in the assessment and management of a severe adult asthma patient.

IH Simulation Program Research Poster

Click image above to see full-page poster

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Notable Achievements Publication - two part series on Simulation Dr. Kevin Clark, Dr. Jared Baylis and JoAnne Slinn published a two-part series on Simulation showcased on a FOAM (Free Open Access Medical education) blog that is quite well-known in the simulation world. 

Part I: Quality Improvement Through Simulation



Part II: ED In-Situ Simulation for Kelowna General Hospital

Simulation Fellowship Dr. Jared Baylis, Kelowna Emergency Resident, participated in the first simulation fellowship at Kelowna General Hospital entitled “Leadership Training in Simulation for Health Education”.

This fellowship was through the Centre of Excellence for Simulation Education Innovation (CESEI). However, hands on simulation experience mostly occurred at the Pritchard Simulation Centre in Kelowna. Dr. Baylis led simulation sessions with emergency medicine and family practice residents, medical students, and staff in the emergency department.

R e s e a r c h a n d f e l l o ws h i p a c t i vi t i e s Dr. Baylis presented research and fellowship activities such as:  Simulation Curriculum Evaluation and Development in a Postgraduate Emergency Medicine Program (Published in BMJ STEL)  Using a common template: a national consensus process among Emergency Medicine educators  Two articles on EMSimCases.com, as noted above, and Learner-Consultant Communication Cases published on emsimcases.com: https://emsimcases.com/2018/04/24/learner-consultant-communication/

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Notable Achievements Emergency Nursing Association of BC Conference (ENAB C) The RFSC in Kamloops hosted the Emergency Nursing Association of BC Conference (ENABC) in September 2017. Preconference sessions were held for Advanced Cardiac Life Support (ACLS) and adult and pediatric simulation.

Concurrent pediatric trauma simulation sessions were held throughout the day.

Simulated Ultrasound Machine A simulated ultrasound machine was built by SIM Tech, Chris Olivier.

Specific case scenario ultrasound videos can be loaded into the system and programed to RFID tags situated on the simulator. When the RFID is scanned with the probe, it launches the video to simulate an ultrasound.

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Professional Development “Attending simulation conferences provides an opportunity to learn, train and knowledge share

with others that are passionate about improving patient safety and quality of care. Staff return with enthusiasm ready to share and implement what they’ve learned”. Shelly Koochin ~~~

Simulation Learning Strategies The Simulation Learning Strategies or Train the Trainer course for simulation educators has been hosted in Interior Health three times, the last being at Kootenay Boundary Regional Hospital (KBRH) in Trail, where Dr. Andrew Sellars and JoAnne Slinn were able to co-facilitate with Dr. Chris Chin who leads the two-day interactive course. The course will provide learners with knowledge of simulation based strategies, identify elements of effective team work, incorporate learning objectives, debriefing skills and how to apply them.

Royal College of Canada Simulation Summit The RKCs participated in inter-disciplinary seminars that included debriefing skills using the Promoting Excellence and Reflective Learning in Simulation (PEARLS) technique; strategies for giving peer instructor feedback, teaching technical skills in simulation, and co-debriefing with other facilitators. As well, they obtained an understanding of the extent simulation is being used and a variety of applications including renovations/facility design, task training, team training, implementation of protocols, staff flow, and improving quality and patient safety

Preventative Maintenance (PM) Course UBC FoM SMP sent Sim Tech, Chris Olivier to a PM course at the Laerdal headquarters in New York. This certification provided more familiarity with software/firmware, programming, diagnostic testing, disassembly/reassembly etc. As we have a partnership between UBC FoM, Interior Health and UBC Okanagan School of Nursing, having an experienced technician with these skills improves the longevity of the Laerdal simulators which in turn provides cost savings for all sites.

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Professional Development Gateway Debriefing Skills Workshop This workshop introduced healthcare education facilitators to the foundational practices of the Debriefing with Good JudgmentŠ method from Harvard University Center for Medical Simulation. All of the RKCs and the Medical Director attended this very valuable learning workshop.

The poster below was brought back from the Gateway Debriefing Skills Workshop and adapted for our sites. The poster is used to convey unconditional positive regard for the participants and to set the stage for a safe and positive learning environment. It is also a reminder for the facilitators that we do believe it and should be fostered.

Basic Assumptions Poster

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Professional Development Simulation Brief Handout (devised from the Strategies to Debriefing Course) – Page 1 The Simulation Brief is a quick guide that is used to assist simulation facilitators to pre-brief, outline objectives for the simulation and debrief using the G-A-S frame-work.

Simulation Brief Handout (page 1)

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P

Professional Development Simulation Brief Handout (devised from the Strategies to Debriefing Course)

Simulation Brief Handout (page 2)

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Professional Development Crisis Resource Management Crisis Resource Management (CRM) refers to the non-technical skills required for effective teamwork in a crisis situation. CRM training improves performance and reduces errors (settings include the emergency department, trauma teams and rapid response teams).

This handout is used in simulation education and hangs in all the simulation centres throughout Interior Health.

Crisis Resource Management Handout

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Education U B C Fa c ul t y o f M e di c i ne – S ou t he r n M e di c a l P r o gr a m (Years 1- 4 Medical Students)

T r a n s i t i o n i n t o C l i n i c a l E d u c a t i o n ( TI CE ) This session takes place in the last two weeks of Year 2 medical training. It supports the transition from classroom-learning to hands-on learning.

Through simulation the students develop the knowledge, skills, and attitudes to become clinical clerks. The TICE simulation sessions were designed provincially with J. Slinn, the RKC playing a large role to assist in supply lists and curriculum development for simulation.

Y e a r 3 S o u t h e r n Me d i c a l P r o g r a m ( S M P ) SMP introduced simulation into their curriculum in the specialties below with one or all sessions running in the simulation centres. The sessions were developed and revised in collaboration with the simulation program across all three sites for: o Anesthesia o Cardiology o Emergency o Internal Medicine o Neurosurgical o Orthopedics o Pediatrics o Surgical o Trauma

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Education U B C Fa c ul t y o f M e di c i ne – F a m i l y M e di c i n e Canadian Residency Simulation Tournament (CReST ) The UBC Faculty of Medicine Department, Family Medicine residents, held a provincial simulation competition at the Pritchard Simulation Centre (PSC) in Kelowna in November 2017. CReST brought Family Medicine Residents together from St. Paul’s, Lions Gate and Kelowna General Hospital’s.

Residents teamed up and ran through critical care cases using the high fidelity adult and pediatric mannequins. Judges looked at assessment, diagnosis, management, disposition, and leadership/teamwork to decide on the winning teams. S e e v i d e o

U B C Fo M F a m i l y P r a c t i c e ( F P ) R e s i d e n c y P r o g r a ms The FP Residency Program in the Interior came together in Kelowna for their annual Bootcamp. The residents rotated through three concurrent stations using adult and pediatric simulators and airway management task trainers.

Other sessions occurring for FP residents included:  Kamloops residents attend monthly simulation sessions;  Peer-Led simulation sessions occur monthly in Kelowna and Trail;  Penticton residents travel to the PSC in Kelowna four times a year for simulation;  Nelson residents travel to Trail for simulation sessions;  Advanced Cardiac Life Support (ACLS) Renewal courses are held in Kelowna and Trail; and  Kelowna and Trail residents attend monthly ED in situ sessions at their respective sites.

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Education K e l ow na E m e r g e nc y M e di c i ne Re s i de nc y P r o gr a m T h e U B C E m e r g e n c y Me d i c i n e I n t e r i o r S i t e This is a 5-year training program satisfying the Royal College requirements for Emergency Medicine. It is based in Kelowna, B.C. with approximately 3 months per year in Vancouver from PGY-2 to PGY-4 inclusive. There are two residents per year, totaling eight residents for the 2017-18 year.

The residents participate in high fidelity simulation sessions once a month in the Pritchard Simulation Centre. The sessions are run by emergency physician facilitators and cover a wide variety of topics including trauma, shock, toxicology, and pediatrics.

E me r g e n c y D e p a r t m e n t ( E D ) i n s i t u These sessions occur in the ED in situ, meaning the environment the staff normally practices in. The aim is to have once monthly sessions, followed by EM Grand Rounds. The objective is to have the interdisciplinary team come together to learn and grow as a team. Staff have found these sessions valuable in improving patient management and teamwork.

One session involved a neonate with a heart defect where the team integrated the Tele PICU cart into the case and performed a live call to British Columbia Children’s Hospital (BCCH) to test the system.

Lots of systems-issues were identified including timely access to an infant warmer.

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Education I nt e r i or He a l t h S a f e Co n s u m p t i o n S i t e Sessions that are held in Kelowna and Kamloops are supported by the RKCs who co-facilitate and provide simulators and equipment. Training has included safe injection and management of overdose and anaphylaxis. Through this training, gaps were identified with regard to calling an ambulance which led to the creation of a guide to better navigate BCEHS dispatch.

M a t e r n i t y Mo r e O B Training sessions occur at the RFSC in Kamloops with the MoreOB core team to prep for skills drills.

VictoriaÂŽ, the birthing simulator, was newly purchased in 2017 with donated funds from Rae Fawcett!

T h e B C S o c i e t y o f Re s p i r a t o r y T h e r a p i s t s ( B CS R T) An educational roadshow at RIH, with RTs from across the province is held annually. Simulation was showcased during the conference using both the adult simulator and airway task trainers allowing participants to practice both basic and advanced airway management techniques.

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Education I nt e r i or He a l t h Mock Code Pinks Mock code pinks or simulated pediatric emergency exercises, are held at KBRH in Trail, aimed to be held monthly in various departments. The RFSC in Kamloops hold these sessions on the Pediatric floor post the Pediatric Advanced Life Support (PALS) course to help solidify the learning.

F i ve A l i ve B l u e a n d W h i t e Scenario training is occurring in situ (on the clinical floors) at KBRH in Trail.

These are short scenarios focusing on initial staff interventions prior to code team arrival (i.e., Basic Life Support and de-escalation). These sessions assist staff to apply training learned in course work to real time/real environment.

J u s t i n T i me Scenarios are being held in the Intensive Care Unit at KBRH in Trail. These scenarios look at identifying the sickest patient on the floor and their worst possible scenario, which is then simulated with staff.

All programs are now branching out to i n s i t u areas of the hospital including:  Ambulatory Care  Day Care  Emergency  Maternity  Medical  Operating Room  Pediatrics  Post Anesthetic Recovery (PAR)  Psychiatry  Surgical

various

Ambulatory Care

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Education Travel Physician/Nurse teams continue to travel to 28 rural and regional hospital sites across the Health Authority to carry out simulated critical care scenarios based on site’s needs assessments.

Below is a map of the rural hospital sites across Interior Health.

Interior Health Emergency Services site map

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Education I H R ur a l M obi l e S i m ul a t i o n P r ogr a m In 2017-18 we expanded the program to include three of the regional hospitals across Interior Health:  Penticton  Vernon  Cranbrook In 2017 more human patient simulators were purchased and are now stationed at the fixed sites in Kelowna, Kamloops, and Trail which provides increased opportunity for rural and regional hospital’s across each region.

With the high-fidelity human patient simulators, we are able to create close to real life experiences in sites’ own emergency or trauma room, utilizing their supplies, equipment, and staff while building or enhancing relationships within their interprofessional teams.

Sites identify their own learning needs and goals which direct the choice of cases or scenarios. These sessions are followed up with post session summaries which identify main learning points that can be shared with all staff at the site.

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Collaboration Provincially Our team assists in the coordination and facilitation of:

M obi l e M e di c a l Uni t ( M M U) The IH Rural Mobile Simulation Program and the MMU team up to provide education in the RV or in situ in the emergency/trauma room. This collaboration could consist of low fidelity Midwifery birthing techniques/skills to a mass casualty that could involve police, first responders, Search and Rescue and hospital personnel using high fidelity simulators.

S i m ul a t i on Tr a u m a U p da t e C o ur s e ( S T R UC ) The objective of this course is to provide a simulation based one day update highlighting skills and knowledge required for the resuscitation of complex trauma patients through simulated exercises. Crisis Resource Management (CRM) principles of leadership, clear closed loop communication, teamwork, resource utilization, situational awareness and problem solving will be emphasized, as well as medical knowledge regarding resuscitation strategies in various clinical scenarios.

Physicians, RTs, and RNs are involved in this valuable training.

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Provincial Initiatives T h e Br i t i s h Col u m bi a S i m ul a t i o n N e tw or k ( BC S N) The BCSN acts as a provincial community of practice aiding British Columbiabased simulation centres with a forum in which to discuss and advance ideas in the intersection of healthcare, simulation, and technology. This network meets to create provincial standardization with respect to clinical tools, debriefing, data collection, rental guidelines/cost matrix, equipment pricing etc. ď‚Ź Modules have been created for Safe Patient Handover as well as principles of Crisis Resource Management.

Check out the sites!

Website

https://bcsimulation.ca

@BCSimNet

BC Simulation Network (closed group)

C l i ni c a l S i m ul a t i o n M a na ge m e n t S ys t e m With funding from UBC Faculty of Medicine, a management system was created which can be used by all provincial simulation centres to input and track activity and evaluation data. Out of this work a Lexicon for B.C. Simulation Centres was also created to standardize data collection and reporting.

C a pi t a l E qui pm e n t P ur c ha s e Co n t r a c t Interior Health undertook a Request for Proposal (RFP) that created a Capital Equipment Purchase Contract for the B.C. Health Authorities. This contract, from one particular vendor, has held pricing for an adult & pediatric simulator from April 2016 - April 2019. Sites have seen significant cost savings with this venture.

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Collaboration with Schools U B C O k a na g a n S c h o ol of Nur s i n g Year 3 nursing students practice maternity and pediatric scenarios in the Pritchard Simulation Centre.

This collaboration involves sharing of resources, space, and simulation equipment which benefits all users of the Pritchard Simulation Centre.

B r i t i s h Col um bi a I ns t i t ut e of T e c h n ol og y ( B C I T ) E m e r g e nc y N ur s i ng Groups consist of 5-6 students who are doing their placement at Kelowna General Hospital. They rotate through four unique simulation sessions that were developed by the RKC and BCIT instructor that include: ACLS, physical assessment & basic interventions, pediatrics, and trauma.

U ni v e r s i t y o f No r t he r n B C ( U NB C ) Rur a l E m e r ge nc y N u r s i ng C o ur s e One section of the rural nursing certificate program through UNBC, has integrated simulation into their end-of-term three day workshop. This workshop is intended to cover the practical aspect of emergency nursing that is not able to be touched on without hands-on learning. It is geared towards the needs of the students, covering topics such as emergency patient assessment, triage, trauma, cardiovascular and respiratory emergencies.

T h o m p s o n Ri ve r ’ s U ni v e r s i t y ( T R U) Re s pi r a t or y T h e r a p y ( R T) P r o gr a m Groups consist of 10 students who are doing their placement at Kelowna General Hospital. Each group rotates through three unique simulation sessions that include ACLS, initial responder, and pediatrics.

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Collaboration with Schools S e l k i r k C ol l e ge N ur s i n g P r ogr a m Nursing students attend ED in situ, Mock Codes and Five Alive simulation training sessions at KBRH in Trail.

S c h o ol Di s t r i c t # 2 3 Prevent Alcohol and Risk-related Trauma in Youth (PARTY) Over 120 local high school students attend the PARTY program in Kelowna and Kamloops.

A team of emergency department staff and emergency responders lead a trauma simulation where participants “walk-in� to a simulated emergency department trauma resuscitation.

J u s t i c e I n s t i t ut e of Br i t i s h C ol um bi a ( J I BC ) The JIBC holds an interprofessional day in Kelowna involving emergency responders, community members and hospital staff. Paramedic students are able to practice life-saving skills during simulated emergencies.

Our RKCs are invited to be part of an expert panel discussion and assist in facilitating with this very interactive day.

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Great Learning Chest Tube Insertion Emergency residents practice chest tube insertions on task trainers at the Pritchard Simulation Centre.

Pediatric Trauma A team of physicians, nurses and respiratory therapists come together for the Simulation Trauma Update Course (STRUC). One scenario involved using our pediatric mannequin to simulate a child that was involved in a MVA.

Emergency Department in situ - KGH Clinicians come together monthly at Kelowna General Hospital (KGH) to practice emergency/trauma scenarios in the emergency room (in situ).

Following the simulation, an email is disseminated to participant’s that includes a case summary, take home points and action items.

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Moulage

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Upcoming in 2018-19  MoreOB Training  National Emergency Nurses Association (NENA) – April 19, 2018  CAEP Conference – May 26-30, 2018  Nelson Research Conference – June 1, 2018  National Forum on Simulation for Quality and Safety – June 12, 2018  Many more upcoming sessions are planned for 2018-19

New Neonate simulator for 2018-19 sessions

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