Using Simulation to Teach Hospital Quality Improvement Measures
Nursing Simulation/Lab Coordinator
Waket Technical Community College
Quality Improvement, Safety, Teamwork and Collaboration
Skills or Simulation Laboratories
This teaching strategy is designed to evaluate the following KSA's:
1. Knowledge: Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families.
2. Skills: Use tools to make processes of care explicit.
3. Attitudes: Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals.
Student nurses should be taught hospital quality improvement efforts while in nursing school. This will help them to better understand the focus of quality care as they enter the hospital setting. The Institute for Healthcare Improvement has developed an Improvement Map for hospitals. This map also serves as a great resource for the development of simulation scenarios that include evidence-based interventions. Many of our patients are elderly. The Improvement Map gives interventions for "Essential Care of Frail Older Patients". These interventions were incorporated into a simulation for an elderly patient with a fractured hip who develops delirium.
The following elements from this IHI map were used:
1. Implement standard processes to assess frail older patients on admission to the hospital (Falls Risk, Polypharmacy, Beers Criteria, Mental Status Assessment).
2. Consider following and putting into place appropriate screening and interventions when necessary for a comprehensive approach to minimizing risk in older patients (CAM assessment for delirium, PAINAD scale for delirium).
3. Consider asking, "What is the greatest hazard that this patient faces?" and establish a prevention and treatment program to address the hazard upon each admission. (In this simulation, the patient develops delirium and the physician orders restraints. Discussion takes place as the student has to use TeamStepps- Advocacy and Assertion to question the order. This leads to discussion of prevention of delirium in this high risk population).
This workshop was funded by a 2012 Perkins Grant. Faculty participated in the simulation and had the opportunity to evaluate this teaching strategy. All acknowledged that teaching quality improvement measures during simulation is important and will ease the transition of our students to the workplace.
Students also participated in this simulation and completed a formative evaluation. All students had a better understanding of the standard processes used to assess the frail elderly on admission to the hospital. All used appropriate screening and interventions during simulation to provide a comprehensive approach to minimizing risk to this population of hospitalized patients. Students gained a better understanding of prevention and treatment of delirium in hospitalized frail elderly patients. Many students lacked the opportunity to work with elderly patients experiencing post-operative delirium and stated that this simulation was valuable.
Faculty choosing to use this teaching strategy can use their own formative evaluation tool. It is best to administer this immediately after the debriefing session. Many include questions related to effectiveness of the debriefing session if this is a new teaching strategy for them.