eSimulation in ActioneSimulation in ActionKettering Medical CenterKettering Medical Center

Sharing Our Success Story Sharing Our Success Story and and

StrategiesStrategies

Laerdal Simulation Users NetworkLaerdal Simulation Users NetworkDianne Ditmer, PhD, RN, CFN, DABFN, FACFEDianne Ditmer, PhD, RN, CFN, DABFN, FACFE

Improving the quality of life Improving the quality of life for the people in the communities for the people in the communities

we serve. we serve. Mission Statement Kettering Medical CenterMission Statement Kettering Medical Center

KETTERING HEALTH NETWORKKETTERING HEALTH NETWORK

Kettering Memorial HospitalKettering Memorial HospitalSycamore HospitalSycamore HospitalKettering Behavioral Medicine CenterKettering Behavioral Medicine Center

Grandview Medical CenterGrandview Medical CenterSouthview Medical CenterSouthview Medical CenterGreen Memorial HospitalGreen Memorial Hospital

And GrowingAnd Growing……....

Our Commitment To ExcellenceOur Commitment To ExcellenceRecognition as Top 100 HospitalsRecognition as Top 100 HospitalsCenters of ExcellenceCenters of Excellence

Stroke CenterStroke CenterChest Pain CenterChest Pain CenterBariatric CenterBariatric CenterJoint Replacement Center Joint Replacement Center Cancer CenterCancer Center

Premier Q AwardPremier Q AwardJD Powers Distinguished Hospital Service JD Powers Distinguished Hospital Service ExcellenceExcellenceBest Place to WorkBest Place to WorkMagnet designation 3 campusesMagnet designation 3 campuses

High achievement always takes High achievement always takes place in the framework of high place in the framework of high

expectation.expectation.Charles F. KetteringCharles F. Kettering

ObjectiveObjectiveEvaluate and implement a Evaluate and implement a comprehensive online staff development comprehensive online staff development programprogramPrioritiesPriorities

HeartCodeHeartCode BLSBLSHeartCodeHeartCode ACLS ACLS Integration of Simulation Integration of Simulation

Background By The NumbersBackground By The Numbers

2250 staff required to maintain BLS 2250 staff required to maintain BLS competencycompetency

30 BLS course offerings30 BLS course offerings

5 courses per month January 5 courses per month January –– JuneJune

80 students per course80 students per course

14 BLS Instructors per course offering14 BLS Instructors per course offering

Background ChallengesBackground ChallengesOff campus facilityOff campus facility

Accommodate large volumes Accommodate large volumes Staff travelStaff travel

EquipmentEquipmentInstructorsInstructors

VolumeVolumeAvailabilityAvailabilitySchedulingSchedulingInterpretation of competencyInterpretation of competency

Staffing scheduleStaffing scheduleChallenge for CNMChallenge for CNMReplacement staffReplacement staffBudget variances Budget variances

Long linesLong linesRefreshmentsRefreshments

Survey The SceneSurvey The Scene

What is the most important issue?What is the most important issue?Connect everything we do to clinical Connect everything we do to clinical outcomesoutcomesSupport the staff at the bedsideSupport the staff at the bedsideEnhance knowledge and competencyEnhance knowledge and competencyAcknowledge learning styles and needs Acknowledge learning styles and needs

Survey The SceneSurvey The Scene

What keeps you up at night?What keeps you up at night?New grads on the night shiftNew grads on the night shiftKeeping core competencies solidKeeping core competencies solidFocusing on patient needs while supporting Focusing on patient needs while supporting staff needsstaff needsClinical excellence, staff excellence while Clinical excellence, staff excellence while meeting financial targetmeeting financial targetTime managementTime managementRegulatory complianceRegulatory compliance

Survey The SceneSurvey The Scene

What do you enjoy most about your What do you enjoy most about your profession?profession?

Collaborative practiceCollaborative practiceMultiMulti--disciplinary approachdisciplinary approachPositive, measurable outcomesPositive, measurable outcomesNurturing staff growthNurturing staff growthSelf governanceSelf governance

Survey The SceneSurvey The Scene

How do you use the Internet?How do you use the Internet?ShoppingShoppingAccess information, musicAccess information, musicEducational resourcesEducational resourcesTravel planningTravel planningSocial networksSocial networksConnections to family and friendsConnections to family and friendsNewsNewsDigital photographyDigital photographyFinancesFinances

What We Were Searching ForWhat We Were Searching ForCost effectiveCost effectiveEvidenceEvidence--basedbased

Inadequate training of nurses is a factor in Inadequate training of nurses is a factor in 58% of serious errors 58% of serious errors (The Joint Commission in Block, (The Joint Commission in Block, ClaffeyClaffey, , KorowKorow & McCaffrey, 2005)& McCaffrey, 2005)

User friendlyUser friendlyReplacement two times salary Replacement two times salary (Barton, Goudy & Hawthorne, 2005)(Barton, Goudy & Hawthorne, 2005)

Easily accessibleEasily accessibleImprove clinical outcomesImprove clinical outcomesRegulatory complianceRegulatory complianceReduce monitoring time by Nursing Reduce monitoring time by Nursing Leadership and EducatorsLeadership and Educators

They just donThey just don’’t get it!t get it!

You teach the same thing over and over but You teach the same thing over and over but they just canthey just can’’t remembert remember……

Sensitivity To Levels Of ExpertiseSensitivity To Levels Of ExpertiseWhat Type Of Support Do They Need?What Type Of Support Do They Need?Novice: experienced nurse in a new settingNovice: experienced nurse in a new setting

Advanced Beginner: new graduate nurseAdvanced Beginner: new graduate nurse

Competent: 2 Competent: 2 --3 years clinical experience3 years clinical experience

Proficient: Nurse clinicians, nursing facultyProficient: Nurse clinicians, nursing faculty

Expert: Advanced practice nurse clinicians Expert: Advanced practice nurse clinicians and faculty and faculty (Benner in Zerwekh & Claborn, 2006, p 14)(Benner in Zerwekh & Claborn, 2006, p 14)

Sensitivity to Generational Sensitivity to Generational Differences and Learning StylesDifferences and Learning StylesTraditionalists Traditionalists –– 5%5%

Written Written –– Visual LearnersVisual LearnersBaby Boomers Baby Boomers –– 45%45%

Love meetings Love meetings -- AuditoryAuditoryGeneration X Generation X –– 40%40%

Video game and PC pros Video game and PC pros Stimuli, multiple strategiesStimuli, multiple strategies

Generation Y Generation Y –– 10%10%Grew up on the Internet, eGrew up on the Internet, e--mail, mail, FacebookFacebookInstant feedback, visual and tactileInstant feedback, visual and tactile

(Dittman, 2005)(Dittman, 2005)

Business PlanBusiness PlanDeveloped and presented a business plan to Developed and presented a business plan to Nursing Leadership and AdministrationNursing Leadership and Administration

Identifying needs Identifying needs

Listing initial and longListing initial and long--term coststerm costs

Calculating longCalculating long--term savings to the term savings to the healthcare systemhealthcare system

Cost AnalysisCost Analysis2007 Traditional BLS2007 Traditional BLS 2008 HeartCode BLS2008 HeartCode BLSRegistered Nurse $354.38Registered Nurse $354.38 Registered NurseRegistered Nurse $41.00$41.00

Licensed Practical Nurse $322.00Licensed Practical Nurse $322.00 Licensed Practical NurseLicensed Practical Nurse $41.00$41.00

Nursing Assistant Nursing Assistant $244.86$244.86 Nursing Assistant $41.00Nursing Assistant $41.00

Registered Nurse $556,376.60Registered Nurse $556,376.60 Registered Nurse $64,370.00 Registered Nurse $64,370.00

Licensed Practical Nurse $58,604.00Licensed Practical Nurse $58,604.00 Licensed Practical Nurse $10,742.00Licensed Practical Nurse $10,742.00

Nursing AssistantNursing Assistant $64,153.32$64,153.32 Nursing Assistant Nursing Assistant $7,462.00$7,462.00

Total CostTotal Cost $679,133.92$679,133.92 Total CostTotal Cost $82, 574.00$82, 574.00

HeartCode BLSHeartCode BLSCost EffectiveCost Effective

Savings $596,559.92Savings $596,559.92Staffing solutionsStaffing solutions

No need to schedule nurses off unitNo need to schedule nurses off unitStaff coverage issuesStaff coverage issuesHours not available for all shiftsHours not available for all shifts

InstructorsInstructorsFacilityFacilityEquipmentEquipment

EvidenceEvidence--based Partnershipbased PartnershipLaerdal Medical Corporation

2007

American Heart Association

Kettering Medical Center

HealthStream2006 Patient

ItIt’’s Not Your Grandmas BLS s Not Your Grandmas BLS AnymoreAnymore

Deployment HeartCode BLSDeployment HeartCode BLSKickKick--off November 2007off November 2007Pilot December 2007Pilot December 2007Go live January 2008 Go live January 2008 Skill LabsSkill Labs

3 campuses3 campuses6 mannequin sets6 mannequin sets6 dedicated computers6 dedicated computers

Labs accessible 24/7Labs accessible 24/7Professional Development staff Professional Development staff available for coachingavailable for coaching

Measures of Success Measures of Success Staff Satisfaction Staff Satisfaction -- BLSBLS

2008200884.2% rated 5/5 (5 Excellent) 84.2% rated 5/5 (5 Excellent) Educational needs met Educational needs met (Survey Monkey, 2008)(Survey Monkey, 2008)

2009 2009 91.2% rated 5/5 (5 Excellent) 91.2% rated 5/5 (5 Excellent) Educational needs met Educational needs met (Survey Monkey, 2009)(Survey Monkey, 2009)

Measures of Success Measures of Success Staff SatisfactionStaff Satisfaction

““Loved the computer feedback!Loved the computer feedback!””

““Love this. It is more realistic.Love this. It is more realistic.””

““I love it this way! I feel I am more prepared should I need to I love it this way! I feel I am more prepared should I need to use my skills.use my skills.””

““This is wonderful. I love the hands on experience and how This is wonderful. I love the hands on experience and how the computer lets you know how you are doing through the the computer lets you know how you are doing through the whole procedure.whole procedure.””

““Great and concise. This ROCKS!Great and concise. This ROCKS!””

““Much better than class. I received precise feedback from the Much better than class. I received precise feedback from the computer.computer.””

““I liked taking the test online and then applying it to the skillI liked taking the test online and then applying it to the skills. s. It made it real.It made it real.””

Measures of Success Measures of Success Clinical OutcomesClinical Outcomes

2007200714% successful resuscitation rate14% successful resuscitation rate

2008200827% successful resuscitation rate 27% successful resuscitation rate

2009200934% successful resuscitation rate34% successful resuscitation rate

““Today, I made a Today, I made a difference!difference!””

Next StepNext StepHeartCode ACLSHeartCode ACLS

ACLS availableACLS available……AWESOMEAWESOME

You get the best efforts from others not by You get the best efforts from others not by lighting a fire beneath them, but by lighting a fire beneath them, but by building a fire within them.building a fire within them.

Deployment HeartCode ACLSDeployment HeartCode ACLS

Pilot 2008Pilot 200850 licenses purchased for trial50 licenses purchased for trial

User GroupUser GroupStaff nurses, medical residents and clinical Staff nurses, medical residents and clinical nurse managersnurse managers

All completed with a passing rateAll completed with a passing rateSatisfaction rate 96% 5/5 met educational Satisfaction rate 96% 5/5 met educational needsneeds

HeartCodeHeartCode ACLS 2009ACLS 2009

567 nurses for recertification of ACLS in 567 nurses for recertification of ACLS in 20092009

Residents and physiciansResidents and physicians

HeartCode ACLS 2009 BenefitsHeartCode ACLS 2009 Benefits

No waiting for available classNo waiting for available classAssignment for new hires instantlyAssignment for new hires instantlyOver 30 days for course completionOver 30 days for course completionTextbook onTextbook on--line and User Guideline and User GuideParticipants can practice at own paceParticipants can practice at own paceCECE’’s upon completions upon completion

Measures of Success Measures of Success Staff Satisfaction Staff Satisfaction -- ACLSACLS

20092009Extremely satisfied 82.3%Extremely satisfied 82.3%

Content met objectivesContent met objectivesContribution to professional effectivenessContribution to professional effectiveness

WhatWhat’’s next? s next? ……High tech, high touchHigh tech, high touch

High Tech High Tech –– High TouchHigh TouchEmbracing technology and patientEmbracing technology and patient--centered, relationshipcentered, relationship--based carebased careNexternship ProgramNexternship ProgramOrientation Orientation –– Collaboration Collaboration

NursingNursingNursing Assistant Nursing Assistant Unit OrientationUnit Orientation

Walking Rounds Walking Rounds –– Unit FocusedUnit FocusedFocused support Focused support –– New GraduateNew GraduateECCO ProgramECCO Program

The New Graduate NurseThe New Graduate Nurse

35% 35% -- 61% of new nursing students 61% of new nursing students leave their place of employment within leave their place of employment within the first year.the first year. (Winter(Winter--Collins & McDaniel, 2000)Collins & McDaniel, 2000)

Supporting Problem Solving SkillsSupporting Problem Solving SkillsSafe EnvironmentSafe Environment

Assessing the problemAssessing the problem

Identifying and analyzing alternativesIdentifying and analyzing alternatives

Making sound decisionsMaking sound decisions

Taking actionTaking action

High Tech High Tech –– High TouchHigh TouchEssentials of Critical Care OrientationEssentials of Critical Care Orientation

64 contact hours64 contact hoursDeveloped by American Association of Critical Developed by American Association of Critical Care NursesCare Nurses25 licenses purchased as trial in 200925 licenses purchased as trial in 2009Students have one year to completeStudents have one year to complete

Hands on with Susan!Hands on with Susan!Integration of simulation with onIntegration of simulation with on--line scenariosline scenarios

High Tech High Tech –– High TouchHigh TouchECCO and BeyondECCO and Beyond

HealthStream courses have been bundled HealthStream courses have been bundled with simulation scenarios to target specific with simulation scenarios to target specific patient populationspatient populations

More handsMore hands--on practice to promote critical on practice to promote critical thinking skillsthinking skills

Integration of simulation with Integration of simulation with multidisciplinary approachmultidisciplinary approach

High Tech High Tech –– High TouchHigh Touch

Susan joins the Air ForceSusan joins the Air Force……

Disaster PreparednessDisaster Preparedness

CalamityvilleCalamityville

High Tech High Tech –– High TouchHigh Touch

Susan goes internationalSusan goes international……

……watch us growwatch us grow

Watch Us GrowWatch Us Grow

Level II NICULevel II NICUTrauma CenterTrauma CenterTransition to Heart TowerTransition to Heart Tower

Six story towerSix story tower23,500 open heart surgeries23,500 open heart surgeries6,000 6,000 cathscaths600 open heart surgeries in 2010600 open heart surgeries in 2010

As We GrowAs We GrowPriorities for 2010 Magnet ViewPriorities for 2010 Magnet View

Transformational LeadershipTransformational Leadership Culture of SafetyCulture of SafetyStaff participation Staff participation –– SNACSNAC

Structural EmpowermentStructural Empowerment Nurse preparation at hireNurse preparation at hireCertificationsCertifications

Exemplary Professional PracticeExemplary Professional Practice Clinical Ladders Clinical Ladders -- MentorsMentorsPI Projects PI Projects –– Simulation ScenariosSimulation ScenariosStaff ResearchStaff Research

New Knowledge, Innovations and New Knowledge, Innovations and ImprovementsImprovements

Level II NICU Level II NICU -- PALSPALSTraumaTraumaEducators Educators -- ResearchResearch

Empirical Quality OutcomesEmpirical Quality Outcomes Resuscitation ratesResuscitation rates

……leaving a legacy for the leaving a legacy for the next generation of Nursesnext generation of Nurses

Sarah age 10Sarah age 10

Malayna age 3Malayna age 3

……for the next generation of for the next generation of patientspatients

Improve the quality of life for the Improve the quality of life for the people in the communities we serve.people in the communities we serve.

Together, with Laerdal, we will save Together, with Laerdal, we will save lives.lives.