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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL Center
SCENARIO OVERVIEW
ESTIMATED PRE-SCENARIO TIME: 10 MINUTESESTIMATED SCENARIO TIME: 20 MINUTES DEBRIEFING/GUIDED REFLECTION TIME: 30 MINUTES
TARGET GROUPS: ALL HEALTH CARE PROFESSIONALS (Nursing, Respiratory Care)
BRIEF SUMMARY:
This case will presents a patient who has been admitted to a rehabilitation care facility for strengthening, due to recent increases in weakness and decreased ADLʼs. The patient will start to experience orthopnea and dyspnea while being treated at this facility. The student(s) will be expected to perform a cardiac and pulmonary assessment, evaluate lab data, recognize lack of response to treatment, communicate findings to the primary care provider, and provide proper management and care including coordinating transport of the patient to an emergency department.
LEARNING OBJECTIVES
GENERAL:
Identifies the primary nursing diagnosisImplements patient safety measuresIdentifies relevant patient history informationExplains physical assessment findings and diagnostics related to patient conditionImplements clinician orders appropriatelyDemonstrates therapeutic and confidential communicationDemonstrates direct and accurate communication with multidisciplinary team membersimplements nursing interventions based on patient care needsPrioritizes nursing interventionsIdentifies indications, contraindications and potential adverse effects of prescribed medications.Demonstrates correct medication administration
SCENARIO SPECIFIC:
Implements a focused cardiac and respiratory assessmentExplains clinical findings and critical lab valuesRecognizes the need for patient transfer to an emergency department setting and obtains orders for transfer.Demonstrates appropriate nursing intervention in a patient with congestive heart failureCompletes necessary paperwork and communication for transition of Care
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EquipmentUniversal precaution equipmentHand SanitizerStethoscopeBlood Pressure CuffSpo2 Monitor with probeThermometerPatient Identification BandOxygen Supply SourceManual Resuscitation Device/BVMOxygen Delivery DevicesEKG Monitor and ElectrodesTapeNormal Saline, IV, IV PumpMoulage Supplies (creams, sponge,cup)Urine Catheter with 80ml Urine (yellow)General Medication Administration SuppliesCPAP EquipmentAllergy Bracelet
Equipment Checklist
SIMS MEDICAL CENTER
Medications and FluidsLasix IV
Nitroglycerin SL Tabs
Morphine IV
Documentation Forms
Physician OrdersData Collection Forms
Diagnostics Available
BNP,CMP, CBC, CPK-MB, Troponin - I, Pre-albumin
CXR PA/LAT
EKG
PREPARATION OF THE SIMULATOR
NUMBER OF PARTICIPANTS
Student Roles:
Instructorʼs Roles:Evaluator and Primary Care Provider available by phone
Two (2) NursesOne (1) Relative - wifeOne (1) Respiratory Care provider
Medical - Rehabilitation UnitPlace in semi-fowlerʼs position in hospital bedApply compression stocking with memory foam to simulate lower extremity edemaDress simulator in patient gown Insert Foley catheter with 80ml yellow urineInsert IV angio with J-Loopapply oxygen 4L/min per nasal cannulaSecure ID Band with patientʼs name, DOB and MR#Chart Prep with H&P, Admission Note, Discharge Summary, Med Reconciliation Form
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
PATIENT DATA:
SIMS MEDICAL CENTER
REPORT TO STUDENTS
ADDITIONAL INFORMATION & MEDICAL HISTORY
TIME: 15:00Peter Stevyanovich is a 71 year old male patient who was admitted to the acute rehabilitation unit three days ago after being transferred from a local hospital with a diagnosis of Acute Decompensated Heart Failure. Peter experienced multiple setbacks during his hospitalization and he has become progressively weakened. His care team recommended transfer to the rehabilitation unit to increase his endurance, improve his ability to perform ADLʼs, reduce his home oxygen usage dependency and return home with the ability to care for himself with limited assistance. Last night, Peter began with complaints of shortness of breath while at rest. The nurse caring for him noticed slight increase in pedal edema, but was unable to weigh Peter due to his fatigue. She contacted his PCP, who then ordered labs, oxygen PRN, and increased his lasix by 10mg BID and scheduled a follow up in two days. Peter remained restless through the night and showed no improvement throughout the day. Upon checking on the patient, the covering nurse found Peter with decreased oxygen saturation at 90% and increased work of breathing. She increased his oxygen level to 4LPM and contacted his PCP. She report to you that she is still waiting for updated labs and a call back from Peterʼs PCP.
CLINICAL SIGNS IMMEDIATELY AVAILABLE
- Restless and appearing uncomfortable- Minor Confusion
MEDICAL RECORD #:PAST MEDICAL HISTORY
RECENT MEDICAL HISTORY:
Male - Age 71 YearsWeight 90 kgs Height 72 inches
DATE OF BIRTH: 06/10/1941
98126534
Mr. Stevanovich has had hypertension for the last ten years. and was diagnosed with atrial fib and congestive heart failure five years ago. He has hyperlipidemia. He had been smoking one pack per day for twenty years but quit four years ago. he is a social drinker only. He is current with his vaccinations and has received his annual flu vaccine. He retired six years ago as a foreman and lives with his wife. He has two grown children who are very supportive to their parents.
Mr. Stevyanovich was admitted to a local hospital due to rapid weight gain and CHF exacerbation. He had been increasingly lethargic and was unable to conduct any adlʼs and began with increased respiratory difficulty. He was released to the rehabilitation unit after a 7 day admission. He is hopeful to regain his strength and return home.
ALLERGIES: Inapsine
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL CENTER
INITIAL STATE (START)
Blood Pressure: 184/88Heart Rate: 110Respiratory Rate 36SPO2: 85% on 4 lpm N/CTemperature 98.8 F
After 5 Minutes
Increase Blood Pressure to: 220/102Increase HR to: 138Decrease SPO2 to 78%(Increased vital sign due to further decompensation)
If care is not being effectively delivered after 10 minutes:
If care is progressing effectively after 10 minutes:
BP to 180/82HR to 118RR Remains 30sp02 to 88%
Increase Blood Pressure to: 260/120Increase Heart Rate to: 150Increase Respiratory Rate to: 44Decrease spo2 to 65%IDecreased LOC
Decrease Blood Pressure to: 162/80Decrease Heart Rate to: 110Decrease Respiratory Rate to: 26with CPAP
If the effectiveness of delivery of care improves:Move Back to Green Box
If care is not being effectively delivered after 15 minutes:
Increase Blood Pressure to: 80/40Increase Heart Rate to: 180Increase Respiratory Rate to: 4unresponsive
If Care is Progressing effectively after 15 Minutes, Decrease vital signs to:
At 30 Minutes, if scenario is not successfully completed, please end scenario and move to debriefing
scenario is successfully when patient is transferred or 30 minutes has elapsed, please end scenario and move to debriefing
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
INITIAL VITAL SIGNS
BP: 184/80HR: 110RR: 36SPO2: 85% (on 4lpm n/c)TEMP: 98.9 F
PERRLs3 GallopLung sounds with crackles throughout bilaterally
Patientʼs wife will try to answer every question for patient even if not asked to.
- Wash Hands- Universal Precautions- Introduce Self- Identify the Patient- Obtains vital signs - Obtains Spo2- Auscultates heart and
lungs- Assess IV site- Evaluate Urine output- Evaluate Lab Data
Patient:“ I am very tired and am having such as hard time breathing”
Patientʼs Wife:“ Last time Peter received Lasix the nurse had to empty the urine bag often..Now he has not gone at all?”
BP: 220/102HR: 138RR: 36SPO2: 78% (on 4lpm n/c)TEMP: 98.9 F
(Increased vital signs due to further decompensation)
Vocal Sound:
“ I donʼt feel any better!”
PT becoming more diaphoretic, slight cyanosis present, pt becomes more agitated.
- Communicate findings directly to PCP
- Receive orders, repeat back
- explain lab values and medications to patient
- request respiratory care provider for assistance
- properly administer one SL NTG
- properly administer 80mg Lasix IV & Morphine 4mg IV
Patientʼs wife:
“ Peter doesnʼt seem right!! he is really short of breath and I havenʼt seem him like this in a long time! please help him!
If treatment is not progressing effectively after 10 minutes, change Vital Signs to:BP: 260/120HR:150RR 44spo2 to 65%decreased loc
Patient will become more less responsive, with increased work of breathing, increased cyanosis and diaphoresis.
- Recognizes Respiratory Distress
- Begins treatment plan listed above
Patientʼs Wife:“ it has been eight hours since the last nurse gave Peter any medicine, Peter has not urinated as much as he usually does and I think the doctor wanted to know”
If students successfully deliver care or turn around errors/delays change vitals signs to:
BP: 180/82HR: 118RR 30spo2 to 88%
Pt become less short of breath with treatment, become calmer and less agitated with increased LOC.
- Documents findings and treatments
- Communicates therapy and treatments to the patient and their family (throughout scenario)
- Communicates findings and needs with fellow health care providers caring for the patient
- Continues to monitor patients vital signs
Patientʼs Wife:
Do you think he is doing any better? Does he need to go the ER?
0 to
5 M
INU
TES
5 to
10 M
INU
TES
10 to
15
MIN
UTE
S15
to 2
0 M
INU
TES
TIM
E VITAL SIGNS(MONITOR SETTINGS)
PATIENT/SIMULATORACTIONS
SIMS MEDICAL CENTER
STUDENT INTERVENTIONS
CUES/PROMPTS
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
If students continue to successfully deliver care or turn around errors/delays change vitals signs to:
BP: 162/82HR: 110RR 26 with CPAPspo2 to 95%
decreased diaphoresisdecreased cyanosisimproved vital signs
- Evaluate Vital Signs- Obtains vital signs - Auscultates lungs- Evaluates Urine output- communicate
therapeutically with patient and family
- Contact PCP for transport request
- Begin transfer paperwork
Patient:“ I am starting to feel a little better”
Pt more alert and occasionally says short sentences
If treatment is not progressing effectively after 20 minutes, change Vital Signs to:BP: 80/40HR:180RR 4spo2 to UTOPt becomes unresponsive
patients eyeʼs closeCyanosis increasesvitals signs decreaserespiratory failure signs and symptoms become more prevalent.
- Recognize Respiratory Failure
- Begin Respiratory Ventilations via BVM
- Request Assistance- Begin Proper
Treatment therapies- Contact PCP
requesting transfer- Call 911
Patientʼs Wife:
“ what is wrong? Why is he not responding to me?? why arenʼt you helping him?? He looks really bad!!!
Help!!! Help!!!
If students successfully deliver care or turn around errors/delays change vitals signs to:
BP: 162/82HR: 110RR 26 with CPAPspo2 at 95-97%
Pt asking when he will be going to the hospital and when can he take the mask off his face.
- Reassess patientʼs vital signs
- Complete transfer paperwork
- contact receiving facility
- communicate patient information to EMS.
Patientʼs Wife:
When is he being transferred to the hospital?
How long will he be there?
Do they know about the changes Dr. Casey made?
SCENARIOHASENDED
20 to
25
MIN
UTE
S20
to 2
5 M
INU
TES
25 to
30
MIN
UTE
S30
MIN
UTE
STI
ME VITAL SIGNS
(MONITOR SETTINGS)PATIENT/SIMULATOR
ACTIONS
SIMS MEDICAL CENTER
STUDENT INTERVENTIONS CUES/PROMPTS
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
PROPOSED CORRECT TREATMENT (OUTLINE)
SIMS MEDICAL CENTER
Wash HandsMaintains Universal PrecautionsIntroduce SelfIdentify the Patient ( Minimum two (2) Patient identifiers)Maintains Patient Privacy (Pull Curtain if Applicable)Auscultate Heart and Lung SoundsObtains Blood PressureObtains Pulse RateObtains Respiratory RateObtains Oxygen Saturation Level (SPO2)Obtains TemperatureAssess IV SiteEvaluate urine outputEvaluate Lab DataRecognizes Respiratory FailureCommunicates findings directly to PCPreceives orders, repeats backExplain lab values and medication to patientRequests assistance from Respiratory care therapyProperly administer Nitroglycerin using the “5 Rights”Properly administer Lasix IV using the “5 Rights”Properly administer Morphine IV using the “5 Rights”Assist Respiratory Care with placement of CPAPEvaluates vital signsEvaluate urine outputAuscultate lungsCommunicate therapeutically with patient and familyCommunicates findings and needs with fellow health care providers caring for the patientRequest approval for transport to Emergency Department for patientCompletes all necessary transfer paperworkContacts receiving facility and gives report about patient
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL CENTER
COMMUNICATION
Actor who should respond
Question by Student Response
Patient What is your Name? Huh??? What did you say??? (Hearing impaired) - Delay true answer
Patient How are you feeling? Tired, a little short of breath
Patient Have you been moving around today? A little, Iʼm Tired and short of breath
Wife How has Peterʼs weight been? He has really been retaining fluid and he had a six pound weight gain in a two day period this week.
Wife Did Peter get his flu vaccination this year? Yes he did. He has been getting one since he quit smoking 10 years ago and decided he wanted to be healthier.
Patient What is your pain level? (Pain Scale) Iʼm just sore from being in the same position for a long time, I need to move but i havenʼt been able to.
Wife Has he ever been intubated before? Yes, but he doesnʼt want to ever have that happen again, he even filled out paperwork for that.
Patient After positioning, how do you feel now? A little better
The following communication suggestions for the patient simulator operator and actors are meant to assist with the flow of the scenario. Please utilize these with open-minded ability to communicate with the students outside this list as necessary to keep the plausibility of the scenario intact:
SUGGESTED COMMUNICATIONS
Patient/Family Questions of Students
Patient Patientʼs Wife
Who are You? Why are you in my room? Whatʼs your name? Who are you? will you be taking care of Peter?
What did you say?? (Displaying hearing issues) When will the doctor come in?
Whereʼs my nurse? Are you my nurse? - Same with MD? When will he start to feel better??
I would like a drink of water, Can i have one? What was that medication you gave Peter?
When will I not need this mask? When can Peter go home?
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL CENTER
DEBRIEFING/GUIDED REFLECTION OVERVIEW
Questions
1 How did the experience feel? What was your main goal of the simulation?
2 Which lab values need to be evaluated for a patient with acute congestive heart failure?
3 Why was lasix, nitroglycerin, Morphine, and CPAP ordered?
4 Describe how you involved family members in patient care being provided.
5 What have you learned from this patient?
6 Describe the scope of practice of all participants in the scenario
7 Describe why you called for help.
8 Did communication include warm handover and closing the loop? How do you know this?
9 Describe how patient information was transferred from one facility to another?
10 What Will You take away from this experience?
CASE CONSIDERATIONS
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Congestive Heart Failure (CHF), or heart failure, is a condition in which the heart canʼt pump enough blood to the bodyʼs other organs. The most common sign of congestive heart failure are edema of lower legs or ankles and/or dyspnea at rest or with minimal exertion. Another symptom is weight gain when fluid builds up. When a specific cause of congestive heart failure is discovered, it should be treated or, if possible corrected.
Monitoring labs during an acute decompensated heart failure episode is important to ensure patient safety and monitor possible side effects of treatment. BNP is a cardiac hormone that will increase during heart failure. Potassium and magnesium are monitored as deficiencies increase the risk of arrhythmias. Creatinine blood level is monitored as a fairly reliable indicator of kidney function.
Administration of lasix helps reduce fluid overload, nitroglycerin and morphine act to vasodilate and pre-load reduce, and CPAP helps to push fluid out of the aveoli,
Patients should be educated regarding not only diet, but also to monitor daily weight and report their weight gain to their physician in order to prevent recurrent episodes of decompensated heart failure.
Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL CENTER
PHYSICIAN ORDERS
PATIENT NAME: Stevyanovich, Peter
DOB: 06/10/1941 MR#: 98126534AGE: 71 Years Old GENDER: MALEHEIGHT: 72 Inches WEIGHT: 90 Kg
DIAGNOSIS:
Congestive Heart FailureFailure to Thrive
NO KNOWN ALLERGIES ALLERGIES AND SENSITIVITIESINAPSINE
DATE TIME PHYSICIAN/PROVIDER ORDER(S) and SIGNATURE
Admit to Rehabilitation Unit
Status - Full Code
4gm Na, low cholesterol diet
Vital signs q 4 hours
Activity - Daily PT, OT, additional movement as tolerated
Daily Weight Checks
Lasix 40mg PO BID
Coreg 3.125mg PO BID
Lisinopril 20mg PO QD
Plavix 75mg PO QD
Coumadin 2.5mg PO QD
Spironolactone 12.5mg PO QD
Insert Foley Catheter
Lasix IV 50mg IV twice/day
D/C po Lasix
Insert IV Angio
T/O Dr. William Caset / Jane Sullivan RN
PHYSICIAN/PROVIDER SIGNATURE Dr. William Casey
DATE 02/25/13
X
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL CENTER
PHYSICIAN ORDERS
PATIENT NAME: Stevyanovich, Peter
DOB: 06/10/1941 MR#: 98126534AGE: 71 Years Old GENDER: MALEHEIGHT: 72 Inches WEIGHT: 90 Kg
DIAGNOSIS:
Congestive Heart Failure Exacerbation
NO KNOWN ALLERGIES ALLERGIES AND SENSITIVITIESINAPSINE
DATE TIME PHYSICIAN/PROVIDER STAT ORDER(S) and SIGNATURE
Oxygen Therapy ( Hi-Flo)
IV Therapy (if not already established)
Determine pre-medication urinary output levels
.4mg Niitroglycerin SL up to 3 dosage (as long as systolic BP remains above 100mm/hg)
80mg Lasix IVP
Morphine Sulfate 4mg IVP now
vitals signs q 5-10 minutes until transfer to Emergency Department
Respiratory Care Consult
CPAP 5-10mm/hg as tolerated
Call urinary output and patient condition after 20 minutes
STAT Labs . - BNP, CMP, CBC, CPK-MB, Tropinin-I, PT-INR, Pre-Albumin
CXR & 12 Lead EKG
PHYSICIAN/PROVIDER SIGNATURE Dr. William Casey
DATE 02/25/13
X
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL CENTER
Laboratory Results
PATIENT NAME: Stevyanovich, Peter
DOB: 06/10/1941 MR#: 98126534AGE: 71 Years Old GENDER: MALEHEIGHT: 72 Inches WEIGHT: 90 Kg
DATE: 24 February 2013Time: 13:10CLLS: J.SmithDIAGNOSIS: Congestive Heart Failure Exacerbation
TEST Results Unit Flag Reference Range
Sodium 149 mmol/L High 135-145
Potassium 3.9 mmol.L 3.6 - 5.2
Chloride 107 mmol/L 101-111
CO2 35 mmol/L High 21-31
Calcium 9.3 mg/dl 8.4-10.2
Glucose 134 mg/dl High 70-105
BUN 10 mg/dl 7-18
Bicarbonate 20 mEq/L Low 22-28
Creatine 1.9 mg/dl High 0.5-1.2
Hemoglobin 12.5 G/dl Low 13-17
Hematocrit 33% % Low 40-51
Digoxin 0.8 ng/ml .8-2.0
platelets 168 Thou/uL 125-390
BNP 300 pg/ml High 0.0-100.0
Troponin-I 11.94 ng/ml <0.15
Creatine Kinase 200 units/L High 38-174
ph 7.48 High 7.35 - 7.45
pre-albumin 46 mg/dl 20-50
INR 2.5 2.0-3.0
CLLS Evaluator Julia Smith MLS ASCP
DATE 02/24/13
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL CENTER
Laboratory Results
PATIENT NAME: Stevyanovich, Peter
DOB: 06/10/1941 MR#: 98126534AGE: 71 Years Old GENDER: MALEHEIGHT: 72 Inches WEIGHT: 90 Kg
DATE: 25 February 2013Time: 14:10CLLS: R. MazzaDIAGNOSIS: Congestive Heart Failure Exacerbation
TEST Results Unit Flag Reference Range
Sodium 130 mmol/L Low 135-145
Potassium 3.9 mmol.L 3.6 - 5.2
Chloride 107 mmol/L 101-111
CO2 44 mmol/L High 21-31
Calcium 9.2 mg/dl 8.4-10.2
Glucose 124 mg/dl High 70-105
BUN 11 mg/dl 7-18
Bicarbonate 18 mEq/L Low 22-28
Creatine 2.1 mg/dl High 0.5-1.2
Hemoglobin 12.5 G/dl Low 13-17
Hematocrit 32% % Low 40-51
platelets 168 Thou/uL 125-390
BNP 626 pg/ml High 0.0-100.0
Troponin-I 13.64 ng/ml <0.15
Creatine Kinase 212 units/L High 38-174
ph 7.55 High 7.35 - 7.45
pre-albumin 46 mg/dl 20-50
INR 2.5 2.0-3.0
CLLS Evaluator Robert Mazza MLS ASCP
DATE 02/25/13
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL CENTER
PATIENT INFORMATION CARD
MEDICATIONS:
Patientʼs Name: Stevyanovich, Peter" Age: 71" " " Gender: MaleWeight: 90 Kgs Height: 72 Inches Primary Care Provider: Dr. W Casey
Diagnosis: Congestive Heart Failure and Failure to Thrive
Past Medical History: Type II Diabetes, HTN, Hyperlipidemia, Peripheral Neuropathy A-Fib, past Smoker
Advanced Directive: Full Code" " " Consent Obtained: Yes
Fall Precautions: Yes Diet: 4gm Na, Low Cholesterol Contact Person: Margaret Stevyanovich (413) 755-5228
MONITORING:
SOCIAL HISTORY:
ACTIVITY OF DAILY LIVING:
ALLERGIES:
DIAGNOSTIC STUDIES:
Coreg 3.125mg twice a dayLasix 4omg twice a dayLisinopril 20mg once a dayPlavix 75mg once a daycoumadin 2.5mg once a daySpironolactone 12.5mg once a day
Inapsine - Anti-Emetic (HIVES)
X X-RaysLabs: CBC, BNO, CMP, CPK-MB, PT-INRTropinin-I, Pre-Albumin
X
X
X
X
Vital Signs - Every HourSPO2Lung and Heart Sounds
Telemetry
Bed Rest, with aggressive PT and OT
Normal ADL - Home, Needs rehabilitation clearance to return to home
Lives with his wife at an home/residence. Is able to ambulate around his home until his hospitalization when patient began with increased shortness of breath and increased weakness. Since then he has been mostly bed bound.RELIGION:" " Jehovah Witness
Medications Brought from Home:
" " None
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
X
SIMS MEDICAL CENTER
PATIENT DOCUMENTATION FORM
SKILL/PROCEDURE
STAFF INITIALS
BLOOD PRESSURE
PULSE/HEART RATE
RESPIRATORY RATE
OXYGEN SATURATION LEVEL (SPO2) Room AIr
OXYGEN SATURATION LEVEL (SPO2) with 02 __ LPM
PAIN LEVEL (Scale 0 - 10)
BLOOD GLUCOSE LEVEL
TEMPERATURE __ oral __ Rectal __ Tempanic
POSITIONING
WOUNDS C = Clean D = Dry I = Intact
WOUNDS BANDAGED
Patient Weight
Dat
e/Ti
me
Patient Name: ____________________________ DOB:________________________MR#:_______________________ PCP:__________________________ Room#:______________
Comments:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL CENTERData Collection Tool
Resident Name:___Peter Stevyanovich_______ DATE of Transfer:__________________________
Student Name:__________________________" FACULTY:______________________________ Student Name:__________________________" Operator:_______________________________
Collectorʼs Name:__________________________" Start Time:___________ End Time:_________
# Question ResponseYes
ResponseNo
Comments
1 Resident Face Sheet (or similar document) Containing patient name, birth date, rehab facility info
2 Reason for Transfer (Check Method)
EMS transfer form Verbal communication
3 Past Medical History (H&P form, MDS)
4 Medication List (MAR, EMR Printout)
5 Allergy List (MAR, Face Sheet)
6 Baseline mental and physical function (seven-day look back, MDS)
7 Advance Directive (DNR Status, Living Will)
8 Recent Vital Signs (vital sign book, nursing notes)
9 Recent Lab Work (Lab Reports)
10 Rehabilitation Unit nurse contact name and phone number (Verbal Communication vs EMS Transfer)
11 Physician contact name (verbal communication, Face Sheet)
Any evidence of the following actions?
12 Name of Ed/Hospital transfer communicated to PCP.Medical record review (nursing notes, progress notes)
13 Resident clinical status on transfer communicated to primary care physicianMedical record review ( nursing notes, progress notes)
14 Evidence of Family/caregiver notificationMedical record review (nursing notes, progress reports)
15 information transferred within 60 minutes of departureMedical Record Review (nursing notes, progress reports)
16 Verbal Follow up with hospital by rehabilitation unitMedical record review ( nursing notes, progress reports)
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
RESIDENT INFORMATION CHECKLIST FOR ED/HOSPITAL TRANSFER
SIMS MEDICAL CENTER
Resident Face Sheet (or similar document) containing patient name, birth date, rehabilitation facility name and phone number.
Reason for transfer (Check Method) EMS Transfer Form Verbal Communication
Past medical History (e.g., annual review, history and physical form, MDS)
Medication List (e.g., medication administration record, EMR printout)
Allergy List (e.g, medication administration record, face sheet)
Baseline mental and physical functioning (e.g., seven day look-back, MDS)
Advance Directive (e.g, DNR status, living will, MOLST)
Recent vital signs (e.g., vital sign book, nursing notes, verbal communication)
Recent lab work (lab reports)
Rehabilitation Facilities contact name and phone number (e.g., verbal communication, EMS transfer form)
THE FOLLOWING INFORMATION IS DOCUMENTED IN THE MEDICAL RECORD:
Name of ED/Hospital transfer communicated to primary care physicianResident clinical status on transfer communicated to primary care physicianEvidence of family/caregiver notificationThe information above was transferred with the resident or within 60 minutes of departure from the facility.
Contact Name:_________________________________________ Time:___________________________
________________________________________________ ____________________________ NAME DATE
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
___________________________________________ _____________________________ RESIDENT NAME Date and time of transfer
SIMS MEDICAL CENTERProficiency Self Report
# Met Not Met
OBJECTIVE E A D N N/A Comments
1 Wash Hands
2 Maintains Universal Precautions
3 Introduce Self and Identifies the Patient ( Minimum two (2) Patient identifiers)
4 Maintains Patient Privacy (Pull Curtain if Applicable)
5 Auscultates Heart and lung sounds
6 Obtains Blood Pressure, pulse rate, respiratory rate, SPO2 levels and temperature
7 Assess IV Site
8 Evaluates Urine Output
9 Evaluates lab Data
10 Recognizes Respiratory Failure
11 Communicates findings directly to PCP
12 Receives orders, repeats back
13 Explain Lab values and medication to patient
14 Request assistance from Resp Care Therapy
15 Properly administers Nitroglycerin, Lasix & Morphine
16 Assist Resp Care with CPAP
17 Evaluates vital signs and urine output & Ascultate Lungs
18 Communicate therapeutically with patient and family
19 Communicates findings and need with fellow health care providers caring for the patient.
20 Requests approval for transport ro ED for patient
21 completes all necessary paperwork
22 Contacts receiving facility and gives report about patient
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
Please rate your performance in the simulation using the following scale: ( See back side for more explanation of levels)E = Exemplary A = Accomplished D = Developing N = Novice N/A or N/O = Not Applicable or Not Observed
STUDENT NAME:____________________________ Date:_______________________
FACULTY NAME:_____________________________
SIMS MEDICAL CENTERFaculty Evaluation Tool
Student Leader:__________________________ DATE:_________________________________
Student Name:__________________________ FACULTY:______________________________
Student Name:__________________________ Operator:_______________________________
Student Name:__________________________ Start Time:___________ End Time:_________
# Met Not Met
OBJECTIVE E A D N N/A Comments
1 Wash Hands
2 Maintains Universal Precautions
3 Introduce Self and Identifies the Patient ( Minimum two (2) Patient identifiers)
4 Maintains Patient Privacy (Pull Curtain if Applicable)
5 Auscultates Heart and lung sounds
6 Obtains Blood Pressure, pulse rate, respiratory rate, SPO2 levels and temperature
7 Assess IV Site
8 Evaluates Urine Output
9 Evaluates lab Data
10 Recognizes Respiratory Failure
11 Communicates findings directly to PCP
12 Receives orders, repeats back
13 Explain Lab values and medication to patient
14 Request assistance from Resp Care Therapy
15 Properly administers Nitroglycerin, Lasix & Morphine
16 Assist Resp Care with CPAP
17 Evaluates vital signs and urine output & Ascultate Lungs
18 Communicate therapeutically with patient and family
19 Communicates findings and need with fellow health care providers caring for the patient.
20 Requests approval for transport ro ED for patient
21 completes all necessary paperwork
22 Contacts receiving facility and gives report about patient
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL CENTEREVALUATION RUBRIC
EXEMPLARY ACCOMPLISHED DEVELOPING NOVICE
- Observes and monitors
- Recognizes subtle changes
- Assertively seeks needed info
- Constantly delegates
- Identifies and independently develops
- Focuses on relevant data
- Observes and monitors
- Recognizes obvious change
- Actively seeks useful info
- Generally delegates with clarity
- Usually flexible with change
- Good self-reflection
- Attempts to observe, overwhelmed
- Notes obvious deviations
- Attempts to prioritize data
- Tentative leadership
- Caring but not competent skills
- Hesitant and ineffective
- Confused
- Unable to note critical data
- Fails to interact
- Disorganized
- Inflexible
- Focused on Single intervention
- Under/Overly critical
Please use the information below as examples of each level of development for this evaluation rubric/tool. Please answer each question honestly to assist you in the educational process.
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Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL CENTERStudent Evaluation Tool
# Question SA A N D SD
1 I understood my role in the scenario
2 I understood the purpose and objectives of the simulation
3 The information I received before the scenario was helpful in preparing me for the scenario
4 The scenario provided me an opportunity to practice critical think skills
5 The scenario resembled a real-life situation
6 I was supported in the learning process
7 My need for help was recognized
8 I was encouraged to explore all possibilities during the simulation
9 I think I would be better able to perform in a related clinical situation after participating in this scenario.
10 The feedback was constructive
11 The debriefing session was helpful in my understanding of the clinical situation and the most appropriate actions for the participant to take.
12 Overall, I think this was a valuable learning experience
What was your role in the scenario:
What was the single greatest thing you got out of this scenario? (If you feel nothing at all from it, please say why you found it so unproductive)
What was most helpful/beneficial about this scenario?
What did you find least helpful/beneficial about the scenario?
In what ways could the scenario be improved or made to be more realistic?
FACULTY NAME:_________________________" " Date:_______________________
Student Name (Optional):________________________ Course:_____________________
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Please choose the answer you feel best represents your simulation experience for the questions belowWe greatly appreciate all of your feedback !!!
SA - Strongly Agree A - Agree N - Neutral D - Disagree SD - Strongly DIsagree
Care Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
SIMS MEDICAL CENTERCare Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
22
REFERENCES
23
• Coleman EA. Transitional Care Performance Measurement. In Institute of Medicine. Performance Measurement: Accelerating Improvement. National Academy of Sciences Press. Washington DC. December 2005.
• Coleman EA, Magid DJ, Beck A, Eilertsen TB, Conner D, Kramer AM. Reducing Emergency Visits in Older Adults with Chronic Illness: A Randomized Controlled Trial of Group Visits. Effective Clinical Practice (An ACP/ASIM Publication). 2001;(2):49-57.
• Coleman EA, May K, Bennett RE. Health Information Exchange in Post Acute and Long Term Care - Task 5.0 Report on HIE in Post-Acute and Long-Term Care. Department of Health and Human Services Assistant Secretary for Planning and Evaluation. Contract #100-03-0028.
• Bennett RE, Tuttle M, May K, Harvell J, Coleman EA. Health Information in Post-Acute and Long-Term Care: Case Study Findings (Final Report). Department of Health and Human Services Assistant Secretary for Planning and Evaluation. Contract #100-03-0028.
• Halasyamani L, Kripalani S, Coleman EA, Schnipper J, van Walraven C, Nagamine J, Torcson P, Bookwalter T, Budnitz T, Manning D. Transition of care for hospitalized elderly - the development of a Discharge Checklist for Hospitalists. Journal of Hospital Medicine. 2006;(1):354-360.
• Jefferies, P. (2007) Simulation in Nursing Education. Laerdal Wappingers Fall, NY
• Lasater, K. Clinical Judgement Development: Using Simulation to Create an Assessment Rubric Journal of Nursing Education. 2007 Vol. 46 (11) : 496-503
• Minor, M. Minor, S. (2009) Patient Care Skills 6th Ed. Prentice Hall, Saddle River, NJ
• Stanhope, M., Lancaster, J. (1996) Community Health Nursing 4th Ed. CH 7 pp 117-135 Mosby Boston, M
SIMS MEDICAL CENTERCare Transitions Education Project (CTEP) Care of the CHF Patient - Part 1
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