Simulation Scenario Template - Wellington Intensive Care …wellingtonicu.com/Data/ANZICSRRT17/Simulation Scenario Template... · ANZICS RRT TRAINING: Simulation Scenario Template

ANZICS RRT TRAINING: Simulation Scenario Template

SECTION 1: Scenario Demographics

SECTION 2: Scenario Developers

SECTION 3: Curriculum Integration

Scenario Title:

Date of Development: (dd/mm/yyyy)

Target Healthcare Worker: Nursing ☐ Medical ☐ Other ☐ Multidisciplinary ☐

Target Experience Level: Undergrad ☐ Postgrad 1-3yrs ☐ Postgrad 4yrs+ ☐ All Groups ☐

Scenario Developer(s):

Affiliations/Institution(s):

Contact eMail:

Learning Goals & ObjectivesEducational Goal:

CRM Objectives:

Medical or Nursing Objectives:

Case Summary: Brief Summary of Case Progression and Major Events

References

Adapted from EMsimcases.com template for ANZICS RRT training course, Sydney 2017 (under a Creative Commons licence)

http://EMsimcases.com


SECTION 4: Scenario Script A. Clinical Vignette: to be read aloud to participants before beginning simulation

B. Scenario Cast & Realism

Patient:

Computerised MannequinRealism:

Select most important dimension(s)

Conceptual ☐

Mannequin Physical ☐

Hybrid Emotional/Experiential ☐

Task Trainer Other

Human Actor N/A ☐

Confederates Brief Description of Role1

2

3

C. Monitoring Required ECG Leads ☐ Temperature Probe ☐ Central Venous Line ☐

NIBP Cuff ☐ Defibrillator & Pads ☐ Capnography ☐

Pulse Oximeter ☐ Arterial Line ☐ Other:

D. Equipment Required Gloves ☐ Nasal Prongs ☐ Scalpel ☐

Stethoscope ☐ Venturi Mask ☐ Tube Thoracostomy Kit ☐

Defibrillator ☐ Non-Rebreather Mask ☐ Cricothyroidotomy Kit ☐

IV Bags/Lines ☐ Bag Valve Mask ☐ Thoracotomy Kit ☐

IV Bolus Medications ☐ Laryngoscope ☐ Central Line Kit ☐

PO Tablets/Spray ☐ Video Laryngoscope ☐ Arterial Line Kit ☐


☐ ☐

☐

☐ ☐


ANZICS RRT TRAINING: Simulation Scenario Template Blood Products ☐ ET Tubes ☐ Other:

Intraosseous Access ☐ LMA or i-gel ☐ Other:

E. Moulage

F. Approximate TimingSet-Up: min Scenario: min Debriefing: min




SECTION 5: Patient Data and Baseline State A. Patient Profile and HistoryPatient Name: Age: Weight: kg

Gender: M ☐ F ☐ Resuscitation Status: Full Active ☐ NFR ☐ Unknown ☐

Presenting Complaint:

History of Presenting Illness:

Past Medical History: Medications:

Allergies:

Social History:

Family History:

Review of Systems:

CNS:

CVS:

Resp:

GI:

GU:

Skin:

Musculoskeletal:

B. Baseline Simulator State and Physical ExamNo Monitor Display ☐ Monitor On, No Data Displayed ☐ Monitor On, Standard Data Display ☐

HR: /min

BP: / mmHg RR: /min SpO2: %

Rhythm: Temp: oC Glucose: mmol/L GCS: (E V M )

General Status:

Oxygen Device: Oxygen Flow: l/min

CNS:



ANZICS RRT TRAINING: Simulation Scenario Template CVS:

Resp:

GI:

GU:

Skin:

Musculoskeletal:




SECTION 6: Scenario Progression

Scenario States, Modifiers and TriggersPatient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State

1. Baseline State Rhythm: HR: /min BP: / RR: /min SpO2: % Temp:

Learner Actions

Modifiers Changes to patient condition based on learner action

Triggers For progression to next state

2. Learner Actions

Modifiers

Triggers

3. Learner Actions

Modifiers

Triggers

4. Learner Actions

Modifiers

Triggers




SECTION 7: Supporting Documents, Laboratory Results, Imaging

Laboratory ResultsNa: K: Cl: HCO3: Urea: Cr: Glu:

Ca: Mg: PO4: Albumin:

ABG or VBG pH: PCO2: PO2: HCO3: Lactate:

FiO2:

WBC: Hb: Hct: Plt:

Others:

Images (ECG, CXR, CT, etc.)




Ultrasound Video Files (if applicable)



ANZICS RRT TRAINING: Simulation Scenario Template SECTION 8: Debriefing Guide

General Debriefing Plan Individual ☐ Group ☐ With Video ☐ Without Video ☐

Objectives Educational Goal:

NTS/CRM Objectives:

Medical Objectives:

Sample Questions for Debriefing 1

2

3

4

5

Key Moments1

2

3

4

5

Key Take Home Message

