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Information on a simulation training program for nursing staff to effectively initiate intravenous access and administer Heparin infusion therapy. learner objectives, scenario purpose, and instructions for setting up the simulation. It is intended for use by Registered Nurses (RN), Licensed Practical Nurses (LPN), and Unlicensed Assistive Personnel (UAP, if facility protocols allow). The scenario lasts approximately 55 minutes, including setup, scenario, debrief, and reset/breakdown.
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Infusion: Heparin
Instructor Information Patient Name: Harrison, Betsy Simulation Developer(s): Melissa Brickner, Bridgett Everett, Debra A. Mosley, Beverly Snyder-Desalles, and Judy Young Scenario Purpose: To assist nursing staff to effectively initiate intravenous access and administer antibiotic infusion therapy Learner(s): Registered Nurses (RN), Licensed Practical Nurses (LPN), Unlicensed Assistive Personnel (UAP) Others as desired, depending on facility protocols Recommend no more than 6 learners (3 of which can be observers) Time Requirements: Setup: 5 minutes Scenario: 25 minutes Debrief: 25 minutes Reset/Breakdown: 5 minutes
Confederate(s): Clerk Dr. Santana – via telephone Family member
Scenario Prologue: Sixty-five (65) year-old female is directly admitted from the outpatient clinic for deep vein thrombosis and Heparin infusion. Patient is s/p right hip fracture with open reduction internal fixation (ORIF) three (3) weeks ago. She just returned from a ten (10) hour car trip. The time is
Patient information: General: Alert, oriented and calm Weight/Height: 81.8kg (180lbs) 177.8cm (70in) Vital Signs: BP 140/84; Temp 97 ; HR 92 ; RR 22 ; O2 Sat 9 7 % Pain: 5/10 right lower extremity Neurological: Unremarkable Respiratory: Eupneic Cardiac: Unremarkable Gastrointestinal: Unremarkable Genitourinary: Unremarkable Musculoskeletal: Right calf red, swollen, and warm to the touch. Pulses +2 bilaterally. Skin: Redness on calf of right lower extremity Past Medical History: Hypertension, hyperlipidemia, osteoarthritis, right hip fracture d/t fall three (3) weeks ago Past Surgical History: Appendectomy, S/P open reduction internal fixation (ORIF) of the right hip three (3) weeks ago Green Text Confederate
Red Text Physiology Change
Medications:
Metoprolol 50mg one time daily Simvastatin 40mg in the evening Ibuprofen 400mg three times a day for pain Allergies:
No known drug allergies (NKDA)
Infusion: Heparin
Discuss the scenario and ask the learners what the main issues were from their perspective Ask what was managed well and why. Ask what they would want to change and why. For areas requiring direct feedback, provide relevant knowledge by stating “I noticed you [behavior]…” Suggest the behavior they might want to portray next time and provide a rationale. “Can you share with us?” Indicate closing of the debriefing but provide learners with an opportunity to voice one or two take-aways that will help them in future practice Lastly, ask for any outstanding issues before closing the debrief Critical Actions/Debriefing Points :
Infusion: Heparin
Simulation Set-Up
Patient Name : Betsy Harrison (ALS Mannequin) Simulation Developer(s): Melissa Brickner, Bridgett Everett, Debra A. Mosley, Beverly Snyder-Desalles, and Judy Young Room Set-up : Set up like an inpatient room Patient Preparation : The patient is wearing a hospital gown Saline lock is in place At 1330, lab draw site is bleeding and there is blood on the sheets from rectal bleeding (see flowchart) Have the following equipment/supplies available : Gloves IV catheter Saline lock with female luer-lock adapter Tape or IV securing device Clear occlusive dressing IV label IV primary tubing (compatible with the pump) Male luer-lock adapter Bag for Heparin infusion (500mL or 250 mL bag) Medication label for Heparin Bloody 2x2 dressing for lab draw site (the family member will discretely apply at 1:30) Simulated blood in a small container or ziplock bag (the family member will discretely empty contents on the pad under patient at 1:30) IV pump Medications : Heparin infusion **Calibration will be required if using radiofrequency identification (RFID)
Note: 5.8 Simpad software update is required to load scenarios (http://cdn.laerdal.com/downloads/f4343/simpad-upgrade.vs Scenarios may be used with Laerdal or LLEAP software
Scenario Supplements : Confederate scripts Confederate name tags Patient Identification Band Medication label for Heparin infusion (facility specific-example provided) Nurse Driven Heparin Protocol (pages 1 and 2) PTT results Heparin protocol (facility specific-example provided) ZZ test patient/Demo patient in CPRS (if desired)
Infusion: Heparin
Supplements
Confederate Scripts
Confederate Name Tags
Patient Identification Band
Nurses Notes
Orders
Heparin Protocol Clinical Process Map Example
Nurse-Driven Heparin Protocol Example (pages 1 and 2)
Medication Label
Infusion: Heparin
Confederate Scripts
Betsy Harrison: Patient
Medical/Surgical History: Hypertension, hyperlipidemia, osteoarthritis, right hip fracture d/t fall three (3) weeks ago. Appendectomy, S/P open reduction internal fixation (ORIF) of the right hip three (3)
weeks ago Medications: Metoprolol 50mg one time daily Simvastatin 40mg in the evening Ibuprofen 400mg three times a day for pain
Allergies: NKDA
If the learner did not perform patient/family teaching or safety check, the patient will become increasingly anxious stating “What is that? You can’t just put medicine in my IV without telling me what it is! Do you know what you are doing?” **After the clerk hands the learner(s) the aPTT results at 1:30, the patient will state “Somebody came and drew my blood and now look at my arm! I need my sheets changed. They got wet after I went to the restroom.”
Family Member** **At 1:30, the clerk will enter the room, distract the learner and hand him/her the aPTT result while the family member places the bloody lab draw dressing on the patient’s arm and empties contents of simulated blood on bed pad under the sheets
Clerk** At 1:30, the clerk will enter the room, distract the learner and hand him/her the aPTT result while the family member places the bloody lab draw dressing on the patient’s arm and empties contents of simulated blood on bed pad under the sheets **Clerk will notify learner Dr. Santana is returning their call
Dr. Santana-Via telephone** The learner(s) will place a call to Dr. Santana Dr. Santana will state “Follow the Heparin protocol, I am getting off the elevator now. I will be there is a minute.”
Infusion: Heparin
Patient Identification Band
Harrison, Betsy
Dr. M. Santana
Age: 65 000-00-
Allergic: NKDA
Patient Identification Band
Infusion: Heparin
Nurses Notes Date : Today Patient Name: Betsy Harrison Mode of Arrival : Personally owned vehicle Accompanied by : Family member
Chief Complaint: Direct admit from the outpatient clinic for deep vein thrombosis and Heparin Infusion. Patient is s/p right hip fracture with open reduction internal fixation (ORIF) three (3) weeks ago. She just returned from a ten (10) hour car trip complaining for right calf pain. Active Problems: Hypertension, hyperlipidemia, and osteoarthritis Patient information: General: Alert, oriented and calm Weight/Height: 81.8kg (180lbs) 177.8cm (70in) Vital Signs: BP 140/84; Temp 97 ; HR 92 ; RR 22 ; O2 Sat 9 7 % Pain: 5/10 right lower extremity Neurological: Unremarkable Respiratory: Eupneic Cardiac: Unremarkable Gastrointestinal: Unremarkable Genitourinary: Unremarkable Musculoskeletal: Right calf red, swollen, and warm to the touch. Pulses +2 bilaterally. Skin: Redness on calf of right lower extremity Past Medical History: Hypertension, hyperlipidemia, osteoarthritis, right hip fracture d/t fall three (3) weeks ago Past Surgical History: Appendectomy, S/P open reduction internal fixation (ORIF) of the right hip three (3) weeks ago
SCREEN FOR ABUSE/NEGLECT: N/A Does the patient show any evidence of abuse? No Does the patient feel safe in his/her current living arrangements? Yes Suicidal or Homicidal Ideation in the past two weeks? No Is the patient currently enrolled in primary care? Yes Diagnostic Procedures Ordered: ( ) X-Ray ( ) Labs ( ) None ( ) EKG ( ) Head CT without contrast ( ) Other Triage Classification: Emergency Severity Index Patient Disposition: Medical-Surgical Unit Signed by : /DM/
Insert picture of patient here
Medications:
Metoprolol 50mg one time daily Simvastatin 40mg in the evening Ibuprofen 400mg three times a day for pain Allergies:
No known drug allergies (NKDA)
Infusion: Heparin
Nurse-driven Heparin Infusion Protocol Clinical Process Map Example Purpose:
Infusion: Heparin
Nurse-Driven Heparin Protocol Example (page 1)
Rounded to nearest 500 Units
Initial Infusion Dose: 18 units/kg/hr then
Response)
PTT (seconds) Bolus (units) Hold Infusion Dose Change
PTT monitoring until 2 consecutive results are within therapeutic range
Infusion: Heparin
Medication Label
Infusion: Heparin