Are We Supposed to Be Measuring Something

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

Презентация: «Are We Supposed to Be Measuring Something». Автор: johnsrd. Файл: «Are We Supposed to Be Measuring Something.pptx». Размер zip-архива: 4101 КБ.

Are We Supposed to Be Measuring Something

содержание презентации «Are We Supposed to Be Measuring Something.pptx»

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3		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 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 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 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 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 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. O’Leary Making Health Care Safer
9		Overview The SMART Training Model Kirkpatrick’s typology Levels of Training Evaluation Organizational Change Literature Review Medicine Aviation
10		Evaluating Training S ynergistic M edical A nd R esource T eam
11		The SMART Training Model Knowledge
12		Crew Resource Management (CRM)
13		Flight 1549 January 15, 2009 Crew Resource Management (CRM)
14		“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, 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 Crew Resource Management (CRM)
17		Purpose-Based Decision Making
18		Emotional Hijacking Working Memory Purpose-Based Decision Making
19		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 “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 Memory—Normal 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 Evidence-Based Practice
23		Experience Simulation
24		Simulation Used in SMART Training Is: Team Based Realistic
25		Simulation Provides the Opportunity to Apply SMART Principles in Realistic Settings AND . . .
26		Facilitates Individual and Team Learning in a Non-Threatening, Ethical and Realistic Environment
27		Teamwork It’s All About Simulation
28		Evaluating Training Kirkpatrick’s typology--1976
29		Evaluating Training: A Multi-Level Approach Kirkpatrick’s typology
30		1. Reaction of the Student to The Training Was the training worthwhile relevant, and interesting? Kirkpatrick’s typology
31		1. Reaction of the Student to The Training Data Can be Captured Through: Feedback Forms (Student Evaluations) Online Feedback Verbal Reaction Kirkpatrick’s typology
32		2. Is There Evidence of Student Learning Assessment of Learning is Based on Ability, Knowledge, and Attitudes Kirkpatrick’s typology
33		2. Is There Evidence of Student Learning Data Collection: - Attitudinal Questionnaires - Assessment Testing (Pre/Post) - Observation and/or Interview - Trained Observers in Simulation Kirkpatrick’s typology
34		3. Is There Behavioral Evidence of Student Learning Is There a Transfer of Knowledge or Application of Skills to the Job? Kirkpatrick’s typology
35		3. Is There Behavioral Evidence of Student Learning Data Collection: - ANTS - SMART Champions - Trained Observers in Simulation Kirkpatrick’s typology
36		4. Is There Evidence of a Training Effect in The Organization/Environment Is There a Clear Correlation Between Training and Organizational Impact? Kirkpatrick’s typology
37		4. Is There Evidence of a Training Effect in The Organization/Environment Data Collection: - Highly Valued - Difficult to Collect - Few Studies Kirkpatrick’s typology
38		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 2006—October 2008 Control: November 2006—October 2007 (2,024 Patients) Experimental: November 2007—October 2008 (1,972 Patients)
39		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 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 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 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 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 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
46		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 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 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 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 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.
«Are We Supposed to Be Measuring Something»