Inside Pediatrics Spring 2015

Inside the Technology

Practice Makes Perfect

mimic symptoms of illness or injury, such as rapid heart rate or shallow breathing. From her keyboard, Tofil can distend the high-tech mannequin’s stomach or make its mouth turn blue from lack of oxygen. She can also dictate the patient’s response to treatment, which often includes “real” injections, IV fluids, intubation and electric defibrillation. “Scenarios can be designed to train learners on a wide variety of illnesses and injuries,” director of education and research Dawn Taylor Peterson, Ph.D, explained. “The simulation experience gives them the opportunity to practice clinical and teamwork skills in a realistic setting without putting a patient at risk.” Mock codes provide real-time clinical experience Once a month, Marjorie Lee White, M.D., director of the UAB Office of Interprofessional Simulation and Education who also serves as adjunct faculty in the PSC, activates a mock trauma code to provide real-time clinical experience in emergency situations. Participants, who often don’t know that the trauma is a simulation until they arrive on the scene, are encouraged to immerse themselves in the scenario, performing all procedures and maneuvers as if the mannequin were a living patient. Tofil also runs a weekly mock code just for residents on service in the pediatric intensive care unit. Those simulations are more in-depth, last longer and include a briefing after the event that allows participants to discuss what they learned and hear feedback from Tofil. “We’re not trying to re-create curriculum,” she said. “But we are trying to bring the curriculum to life.” A key part of simulation training is the presence of “family” members. They allow participants to practice interacting with distraught parents during a high- stress situation as well as how best to approach death and dying discussions. The curriculum As the center begins its seventh year, Tofil and her colleagues have expanded the educational offerings to provide

more in-depth experiences and to address more complex scenarios that extend beyond the specific clinical skills employed at the bedside. One of the new courses addresses communication between nurses and physicians, and the mental pitfalls that often exist that can hamper patient care. The three-part course includes a computer-based training module that includes real-life stories, a simulation in the PSC and finally, a “worst case scenario” simulation on the patient unit. This is Children’s first course required for every nurse in the organization that utilizes the PSC. “Because everyone is doing it, it will affect the culture,” Tofil said. “It has the reach to affect the whole institution.” Another method used in the PSC teaches participants to use a very specific set of

Practice makes perfect in any setting, but in the hospital setting, it can also mean the difference between life and death. At Children’s of Alabama, that valuable practice is provided by the Pediatric Simulation Center (PSC), where students, residents and staff members from a wide variety of disciplines learn how to care for critically ill youngsters via high-tech equipment and simulated scenarios. Children’s PSC is the only pediatric simulation center in the state of Alabama. It was established in 2007 to provide physicians, nurses, respiratory therapists, pharmacists, students and other health care professionals with opportunities to perform common medical procedures and respond to rare, complex conditions and life-threatening emergencies in a safe, realistic environment. Critical care intensivist Nancy M. Tofil, M.D., M.Ed, serves as medical director. Staff includes physicians, nurses, educators and 20 to 30 adjunct faculty. Last year, more than 7,000 learners received training through the PSC during 690 sessions and 1,045 hours of simulation. More than half were licensed and credentialed staff, including physicians, nurses, respiratory therapists, pharmacists, radiology technicians and even chaplains. More than 40,000 learners have received training since an identity and a medical history, and can talk and breathe. Each has a pulse and a variety of anatomical features that allows learners to practice venous access, CPR, airway management, intravenous drug delivery, defibrillation, cardioversion and external pacing. The simulators have realistic heart, lung and bowel sounds and can provide ECG, arterial, invasive and noninvasive blood pressure, intracranial, central venous pressure and oximetry. Each mannequin is directly connected — four of them wirelessly — to a laptop computer where Tofil and other educators can digitally manipulate many of its bodily functions to the PSC opened. The patients Ten high-fidelity simulators comprise the patient population of Children’s PSC. Each represents a child of a different age, from premature infant to teenager. Each has

PSC medical director Dr. Nancy Tofil and a staff of full-time certified educators and adjunct faculty provide hands-on training to 7,000-plus learners every year.

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