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The Institute for Patient Safety and Medical Simulation Baptist
The Institute for Patient Safety and Medical Simulation Baptist
The Institute for Patient Safety and Medical Simulation Baptist
The Institute for Patient Safety and Medical Simulation Baptist
The Institute for Patient Safety and Medical Simulation Baptist
The Institute for Patient Safety and Medical Simulation Baptist
Who Are We
Who Are We
22,500 Square Feet 2 ICU/ED/Med-Surg Simulation Rooms OR Suite 12 Bed
22,500 Square Feet 2 ICU/ED/Med-Surg Simulation Rooms OR Suite 12 Bed
Our Partners
Our Partners
We Are All About Error Reduction
We Are All About Error Reduction
With the growing knowledge that millions of patients are being harmed
With the growing knowledge that millions of patients are being harmed
Overview
Overview
Evaluating
Evaluating
The SMART Training Model
The SMART Training Model
Crew Resource Management (CRM)
Crew Resource Management (CRM)
Flight 1549 January 15, 2009
Flight 1549 January 15, 2009
CRM is not and never will be the mechanism to eliminate error and
CRM is not and never will be the mechanism to eliminate error and
The safety of operations is influenced by professional,
The safety of operations is influenced by professional,
Team Communication Process (Protocol) and Patterned Communications
Team Communication Process (Protocol) and Patterned Communications
Purpose-Based Decision Making
Purpose-Based Decision Making
Emotional Hijacking Working Memory
Emotional Hijacking Working Memory
Emotional Hijacking
Emotional Hijacking
Working Memory
Working Memory
Working MemoryNormal Lapses
Working MemoryNormal Lapses
Knowledge
Knowledge
Experience
Experience
Simulation Used in SMART Training Is: Team Based Realistic
Simulation Used in SMART Training Is: Team Based Realistic
Simulation Provides the Opportunity to Apply SMART Principles in
Simulation Provides the Opportunity to Apply SMART Principles in
Facilitates Individual and Team Learning in a Non-Threatening, Ethical
Facilitates Individual and Team Learning in a Non-Threatening, Ethical
Teamwork
Teamwork
Evaluating Training
Evaluating Training
Evaluating Training: A Multi-Level Approach
Evaluating Training: A Multi-Level Approach
1. Reaction of the Student to The Training Was the training worthwhile
1. Reaction of the Student to The Training Was the training worthwhile
1. Reaction of the Student to The Training Data Can be Captured
1. Reaction of the Student to The Training Data Can be Captured
2. Is There Evidence of Student Learning
2. Is There Evidence of Student Learning
2. Is There Evidence of Student Learning
2. Is There Evidence of Student Learning
3. Is There Behavioral Evidence of Student Learning
3. Is There Behavioral Evidence of Student Learning
3. Is There Behavioral Evidence of Student Learning
3. Is There Behavioral Evidence of Student Learning
4. Is There Evidence of a Training Effect in The
4. Is There Evidence of a Training Effect in The
4. Is There Evidence of a Training Effect in The
4. Is There Evidence of a Training Effect in The
Our Results
Our Results
Our Results
Our Results
Reintubation: An unexpected reintubation is defined as an intubation
Reintubation: An unexpected reintubation is defined as an intubation
Unplanned Admissions to a Critical Care Unit: These admissions are
Unplanned Admissions to a Critical Care Unit: These admissions are
Post-operative Complications: These are defined as bleeding or
Post-operative Complications: These are defined as bleeding or
Our Results
Our Results
Our Results
Our Results
Selected Research
Selected Research
Selected Research: Nursing
Selected Research: Nursing
Selected Research: Health Care
Selected Research: Health Care
Selected Research: Health Care
Selected Research: Health Care
Selected Research: Health Care
Selected Research: Health Care
Selected Research: Aviation
Selected Research: Aviation

: Are We Supposed to Be Measuring Something. : johnsrd. : Are We Supposed to Be Measuring Something.pptx. zip-: 4101 .

Are We Supposed to Be Measuring Something

Are We Supposed to Be Measuring Something.pptx
1 The Institute for Patient Safety and Medical Simulation Baptist
2 The Institute for Patient Safety and Medical Simulation Baptist
3 The Institute for Patient Safety and Medical Simulation Baptist

The Institute for Patient Safety and Medical Simulation Baptist

Health/Auburn University Montgomery, Alabama Are We Supposed to Be Measuring Something? Randy Johnson, Ph.D. & Judi Miller, MSN, RN

4 Who Are We

Who Are We

Hospital Based Simulation Center 3 Hospitals in Montgomery, Alabama 3,000+ Employees 450 Patients Community Focused Faith Based

5 22,500 Square Feet 2 ICU/ED/Med-Surg Simulation Rooms OR Suite 12 Bed

22,500 Square Feet 2 ICU/ED/Med-Surg Simulation Rooms OR Suite 12 Bed

Simulation Lab Pediatric Simulation Lab 2 Pre-Hospital Simulation Rooms Cardiac Simulation Lab 6 Task Training Rooms

The Institute for Patient Safety and Medical Simulation

6 Our Partners

Our Partners

Baptist Health Auburn University Residency Programs Area Schools of Nursing Pre-Hospital Providers Alabama Department of Public Health Healthcare Career Programs

7 We Are All About Error Reduction

We Are All About Error Reduction

Institute of Medicine Reports Josie King Story Crew Resource Management

http://www.baptistfirst.org/careers/

8 With the growing knowledge that millions of patients are being harmed

With the growing knowledge that millions of patients are being harmed

daily throughout the world as a consequence of preventable adverse events, the urgency could not be greater for patient safety solutions that will help practitioners and health care organizations avoid these tragic occurrences. - Dennis S. OLeary

Making Health Care Safer

9 Overview

Overview

The SMART Training Model Kirkpatricks typology Levels of Training Evaluation Organizational Change Literature Review Medicine Aviation

10 Evaluating

Evaluating

Training

S

ynergistic

M

edical

A

nd

R

esource

T

eam

11 The SMART Training Model

The SMART Training Model

Knowledge

12 Crew Resource Management (CRM)

Crew Resource Management (CRM)

13 Flight 1549 January 15, 2009

Flight 1549 January 15, 2009

Crew Resource Management (CRM)

14 CRM is not and never will be the mechanism to eliminate error and

CRM is not and never will be the mechanism to eliminate error and

assure safety in a high-risk endeavor Helmreich, Merritt, and Wilhelm, (1999) The International Journal of Aviation Psychology

Crew Resource Management (CRM)

15 The safety of operations is influenced by professional,

The safety of operations is influenced by professional,

organizational, and national cultures and safety requires focusing each of these toward an organizational safety culture that deals with errors nonpunitively and proactively. Helmreich, Merritt, and Wilhelm, (1999) The International Journal of Aviation Psychology

Crew Resource Management (CRM)

16 Team Communication Process (Protocol) and Patterned Communications

Team Communication Process (Protocol) and Patterned Communications

Crew Resource Management (CRM)

17 Purpose-Based Decision Making

Purpose-Based Decision Making

18 Emotional Hijacking Working Memory

Emotional Hijacking Working Memory

Purpose-Based Decision Making

19 Emotional Hijacking

Emotional Hijacking

Emotions can quickly hijack other brain processes, diverting attention, and determining what will be remembered, and what won't. (Eide, F., Eide, B., http://stanford.wellsphere.com/brain-health-article/emotional-hijack/469427)

Purpose-Based Decision Making

20 Working Memory

Working Memory

The ability to hold in mind information in the face of potentially interfering distraction in order to guide behavior. Jarrold & Towse, Individual Differences in Working Memory, 2006

Purpose-Based Decision Making

21 Working MemoryNormal Lapses

Working MemoryNormal Lapses

Purpose-Based Decision Making

The occurrence of lapses may be critical in occupational groups with a need to maintain a high level of alertness Lapses in these occupations can have disastrous consequences, including multiple fatalities. Peiris, Davidson, & Bones, Event-based Detection of Lapses of Responsiveness, 2008

22 Knowledge

Knowledge

Evidence-Based Practice

23 Experience

Experience

Simulation

24 Simulation Used in SMART Training Is: Team Based Realistic

Simulation Used in SMART Training Is: Team Based Realistic

25 Simulation Provides the Opportunity to Apply SMART Principles in

Simulation Provides the Opportunity to Apply SMART Principles in

Realistic Settings AND . . .

26 Facilitates Individual and Team Learning in a Non-Threatening, Ethical

Facilitates Individual and Team Learning in a Non-Threatening, Ethical

and Realistic Environment

27 Teamwork

Teamwork

Its All About

Simulation

28 Evaluating Training

Evaluating Training

Kirkpatricks typology--1976

29 Evaluating Training: A Multi-Level Approach

Evaluating Training: A Multi-Level Approach

Kirkpatricks typology

30 1. Reaction of the Student to The Training Was the training worthwhile

1. Reaction of the Student to The Training Was the training worthwhile

relevant, and interesting?

Kirkpatricks typology

31 1. Reaction of the Student to The Training Data Can be Captured

1. Reaction of the Student to The Training Data Can be Captured

Through: Feedback Forms (Student Evaluations) Online Feedback Verbal Reaction

Kirkpatricks typology

32 2. Is There Evidence of Student Learning

2. Is There Evidence of Student Learning

Assessment of Learning is Based on Ability, Knowledge, and Attitudes

Kirkpatricks typology

33 2. Is There Evidence of Student Learning

2. Is There Evidence of Student Learning

Data Collection: - Attitudinal Questionnaires - Assessment Testing (Pre/Post) - Observation and/or Interview - Trained Observers in Simulation

Kirkpatricks typology

34 3. Is There Behavioral Evidence of Student Learning

3. Is There Behavioral Evidence of Student Learning

Is There a Transfer of Knowledge or Application of Skills to the Job?

Kirkpatricks typology

35 3. Is There Behavioral Evidence of Student Learning

3. Is There Behavioral Evidence of Student Learning

Data Collection: - ANTS - SMART Champions - Trained Observers in Simulation

Kirkpatricks typology

36 4. Is There Evidence of a Training Effect in The

4. Is There Evidence of a Training Effect in The

Organization/Environment Is There a Clear Correlation Between Training and Organizational Impact?

Kirkpatricks typology

37 4. Is There Evidence of a Training Effect in The

4. Is There Evidence of a Training Effect in The

Organization/Environment Data Collection: - Highly Valued - Difficult to Collect - Few Studies

Kirkpatricks typology

38 Our Results

Our Results

Baptist Medical Center East PACU Staffing: Five or six nurses per day Patient Population: 3,996 patients during the 24 month study Study Period: November 2006October 2008 Control: November 2006October 2007 (2,024 Patients) Experimental: November 2007October 2008 (1,972 Patients)

39 Our Results

Our Results

Patient Safety: Freedom from accidental injury, or avoiding injuries or harm to patients from care that is intended to help them. Ensuring patient safety involves the establishment of operational systems and processes that minimize the likelihood of errors and maximizes the likelihood of intercepting them when they occur. Complication: An injury caused by medical management rather than by the underlying disease or condition of the patient. In general, adverse events prolong the hospitalization, produce a disability at the time of discharge, or both.

40 Reintubation: An unexpected reintubation is defined as an intubation

Reintubation: An unexpected reintubation is defined as an intubation

that occurs in PACU after anesthesia has extubated the patient in surgery and the patient has been able to maintain their airway prior to placement in the PACU.

Our Results

Patient Safety Indicants:

The six areas of evidence used are: 1. Face Validity, 2. Precision, 3. Minimum Bias, 4. Construct Validity, 5. Fosters Real Quality Improvement, 6. Application

41 Unplanned Admissions to a Critical Care Unit: These admissions are

Unplanned Admissions to a Critical Care Unit: These admissions are

defined as an unexpected decline in patient status and requiring a higher level of care. All PACU patients identified in advance as requiring postoperative ICU/CCU care were excluded from the data.

Our Results

Patient Safety Indicants:

The six areas of evidence used are: 1. Face Validity, 2. Precision, 3. Minimum Bias, 4. Construct Validity, 5. Fosters Real Quality Improvement, 6. Application

42 Post-operative Complications: These are defined as bleeding or

Post-operative Complications: These are defined as bleeding or

cardiovascular issue(s) requiring unplanned treatment. Untreated, such complications would lead to a rapid worsening in the patients condition.

Our Results

Patient Safety Indicants:

The six areas of evidence used are: 1. Face Validity, 2. Precision, 3. Minimum Bias, 4. Construct Validity, 5. Fosters Real Quality Improvement, 6. Application

43 Our Results

Our Results

The six areas of evidence used are: 1. Face Validity, 2. Precision, 3. Minimum Bias, 4. Construct Validity, 5. Fosters Real Quality Improvement, 6. Application

44 Our Results

Our Results

The six areas of evidence used are: 1. Face Validity, 2. Precision, 3. Minimum Bias, 4. Construct Validity, 5. Fosters Real Quality Improvement, 6. Application

45 Selected Research

Selected Research

46 Selected Research: Nursing

Selected Research: Nursing

Simulator Effects on Cognitive Skills and Confidence Levels (Brannan & Bezanson, 2008) 107 baccalaureate nursing students junior level Traditional lecture method vs Human patient simulators Treating patients with acute myocardia infarction

47 Selected Research: Health Care

Selected Research: Health Care

Kao, L., & Thomas, E. (2008). "Navigating Towards Improved Surgical Safety Using Aviation-Based Strategies". Journal of Surgical Research, 134, 327-335. Morey, J., Simon, R., Jay, G., Wears, R., Salisbury, M., Dukes, K., et al. (2005). "Error Reduction and Performance Improvement in the Emergency Department through Formal Teamwork Training: Evaluation Results of the MedTeams Project".

48 Selected Research: Health Care

Selected Research: Health Care

Baker, C., Pulling, C., McGraw, R., Dagnone, J., Hopkins-Rosseel, D., & Medves, J. (2008). "Simulation in Interprofessional Education for Patient-Centered Collaborative Care". Journal of Advanced Nursing 372-379. Davenport, D., Henderson, W., Mosca, C., Khuri, S., & Mentzer, R. (2007). "Risk-Adjusted Morbidity in Teaching Hospitals Correlates with Reported Levels of Communication and Collaboration on Surgical Teams but Not with Scale Measures of Teamwork Climate, Safety Climate, or Working Conditions". The Journal of the American College of Surgeons 205(6), 778-784. Grogan, E., Stiles, R., France, D., Speroff, T., Morris, J., Nixon, B., et al. (2004). "The Impact of Aviation-Based Teamwork Training on the Attitudes of Health-Care Professionals". The Journal of the American College of Surgeons, 199(6), 843-849. Guerlain, S., Turrentine, F., Bauer, D., Calland, J., & Adams, R. (2008). "Crew Resource management Training for Surgeons: Feasibility and Impact". Cognition, Technology & Work, 10, 255-264.

49 Selected Research: Health Care

Selected Research: Health Care

Nishisaki, A., Keren, R., & Nadkarni, V. (2007). "Does Simulation Improve Patient Safety?: Self-Efficacy, Competence, Operational Performance, and Patient safety". Anesthesiology Clinics 25, 225-236.

Sundar, E., Sundar, S., Pawlowski, J., Blum, R., Feinstein, D., & Pratt, S. (2007). "Crew Resource Management and Team Training". Anesthesiology Clinics 25, 283-300. Wetzel, C., Kneebone, R., Woloshynowych, M., Moorthy, K., & Darzi, A. (2006). "The Effects of Stress on Surgical Performance". The American Journal of Surgery 191(5-10), 5.

50 Selected Research: Aviation

Selected Research: Aviation

O'Connor, P., Campbell, J., Newon, J., Melton, J., Salas, E., & Wilson, K. A. (2008). "Crew Resource Management Training Effectiveness: A Meta-Analysis and Some Critical Needs". The International Journal of Aviation Psychology 18(4), 353-368. Salas, E., Burke, C., Bowers, C., & Wilson, K. (2001). Team Training in the Skies: Does Crew Resource Management (CRM) Training Work?. Human Factors 43(4), 641-674. Salas, E., Wilson, K., Burke, C., & Wightman, D. (2006). Does Crew Resource Management Training Work? An Update, an Extension, and Some Critical Needs, Human Factors 48(2), 392-412.

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