Pediatric Competency Development

1. Pediatric Competency Development Bridget Mudge, RN, MS Judy Kertis RN BSN Pediatric Clinical Nurse Specialist

2. Objectives • Determine didactic content • Creating scenarios • Integrating core practice issues in to simulations • Evaluating performance

3. OVERVIEW:Pediatric Nurse Residency • 4 components. • 16-week program. • Each week two (2) class days: • Web-based learning. • Didactic with experts to review institutional specific. • Followed by simulations. • Two days of eight-hour clinical; then progresses to 12 hours after 8 weeks.

4. Orientation Content: Clinical Orientation Identify common patient diagnosis (e.g. Neuro, Oncology, Resp distress: RSV) Problem prone areas ( Medication delivery, Isolation) Skills or tasks ( Blood administration)

5. Orientation Content Complex skills or infrequent skills ( Chest tubes) High Risk: Sedation Clinical Questions asked ( How do you evaluate seizures) New processes or skills National patient safety goals Feedback

6. Simulation Additional Uses • Add National Safety Goals: Medication safety. Patient Identification. Clinical Alarms. Verbal Orders. Critical Labs.

7. PROGRAM COMPONENTS:Pediatric Nurse Residency Web-based: Pediatric intensive-care course developed by Indiana University (http://original-oncourse.iu.edu).

8. WEB-BASED LEARNING MODULES:PEDIATRIC CRITICAL CARE Psychosocial Renal/Endocrine Respiratory GI Cardiovascular Neurology Multi-system Comfort Hematology/Oncology Immunology

9. COMPONENT OF PROGRAM:DIDACTIC • Didactic with specialist/ unit experts: • Respiratory: CF, Asthma, RSV. • Pain Management: Assessment Tools, PCA, Epidurals, Pain Free Program. • Developmental Aspects: Chronic Illness, Bereavement. • Cardiac: CHF, Cardiac Cath Postoperative Care.

10. COMPONENT OF PROGRAM:DIDACTIC • Family-centered Care. • Wound and Skin: Braden Q. • Nutrition: Feeding Techniques, Formula, GU Care. • Responding to Medical Emergencies. • Orthopedic Care. • GI Care.

11. COMPONENT OF PROGRAM:DIDACTIC • Diabetic Care: Management and Teaching. • Organ Donation. • Pre- and Post-Op Care. • Child Abuse. • Communication: SBAR. • Transfer and Discharge Planning. • IV Central Line Care. • Newborn.

12. COMPONENT OF PROGRAM:DIDACTIC • Trauma Care. • PICU Specific: Ventilators, EKG monitoring, Defibrillator, IV Therapy, Vasoactive Medications, ICP, Hemodynamic Monitoring.

13. SIMULATIONS: Simulation Development • Who, What? • Sample: • Airway Management. • RSV.

14. Simulations • Seizures. • EEG Monitoring. • Responding to Medical Emergencies • Documentation • Admission • Trauma • Diabetes

15. Simulation development Diabetes: • Who: Unit experts • What: Frequently asked questions of the expert Chart review for orders Review of standards of care for diabetes Patient Education

16. Simulation development • RSV Review of standards and skills Isolation Room set up Nasal cannula application Patient Education

17. Simulation development • Time out • SBAR • Team building

18. CHALLENGES: • Logistics: Ideal number of new grads. • Schedule: Presenters. Preceptors around fixed classes. • Securing lab and Sim Baby.

19. CHALLENGES: Simulation: • How complicated to make scenarios? • Scenarios consistent? • Ideal class size?

20. CHALLENGES:What is best done in simulation? Responding to medical emergencies. Skin Care and Diabetic Education versus

21. Evaluation • What are critical Clinical Behaviors? • Objective information • Experts evaluate • Final Simulation = Integration of skills • Pass / Fail

22. OUTCOMES: • Increased proficiency and accuracy with technical skills. • Developed skills as team members. • Developed relationships with the clinical experts and learned to utilize a variety of resources.

23. OUTCOMES: • The simulations became a place to learn about safety and how errors can and do occur. • Experienced staff members stated an increase in their own knowledge by their participation in the didactic.

24. Pediatric Residents

25. Global Scores for Pediatric Residents

26. CONCLUSIONS: • Utilizing a nurse residency program provides: Opportunities to become safe, competent caregivers.

27. CONCLUSIONS: • Receive immediate feedback on scenario vignettes and quizzes to enhance individual learning and review. • Human patient simulation supports the organizational initiatives related to patient safety and addresses the unique needs of the pediatric population.