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Home > Simulations > Simulation 1: Haiti Earthquake

Scenario #1: Haiti Earthquake, Mrs. Flore Paui

Flore Paui

Learner Group: 2nd year PT/OT students need not have not been to clinic yet

Environment: Acute care hospital room

Authors: Karen Panzarella, PT, Ph.D., Nicki Silberman, PT, DPT

Facilitation Directions

Main Focus

  1. Safely organize hospital room, including lines/monitors and furniture for safe patient mobility
  2. Identify and communicate discharge disposition to team members including patient, family, case manager
  3. Determine if patient can safely participate in rehabilitation session and why she is reluctant to participate
C/T/B Main Focus CAPTE Criteria Performance Measures
1B G 2.2.2. 3.3.2.1 cc-5.11 Maintains professional behavior in verbal and nonverbal communication in all interactions
2B G cc-5.17 Introduces self to patient, family, team members
3T/B G P-10 Sanitizes hands prior to patient contact
4C/T G Confirms patient identity by verbalizing name and checking wrist band
5C/T 3 Checks patient chart for Rehab orders (OOB, PT, OT, WB Status)
6C/T 3 Cc 5.30 Conducts screening examination to ensure patient clear for participation in OT/PT (VS, ROM, Pain, skin inspection)
7T 1 Safely removes CPM (if available)
8T 1 3.3.2.8.28 Moves all lines to 1 side of the bed for safe patient transfer
9T 1 3.3.2.8.8 3.3.2.7.7 Sets up wheelchair and ensures locks on both chair and bed prior to transfer
10C 2 3.3.2.17 Identifies patient not safe/ready for discharge to home, especially to travel back to Haiti
11C/B 2 3.3.2.1 Responds appropriately to questions regarding discharge disposition to both family and team members
12C/B 3 Recognizes the lack of patient participation in rehab may be culturally based

Synopsis of Scenario

Skills/Tasks/Procedures

  1. Screening assessment skills (VS, pain, ROM)
  2. Transfer training
  3. Gait training
  4. Team communication skills
  5. Knowledge of discharge disposition options

Imbedded Challenges

  1. Lines (Foley, IV, PCA) not set up on same side of bed
  2. CPM in place(if available) or knee wrapped, room NOT set up for safe transfer
  3. Daughter asks when mother will be able to return home to Haiti, she wishes to bring her home very soon
  4. SW asks to confirm discharge plan to home. OT states patient is ready for discharge
  5. Patient complains of too much pain to walk and believing rest is necessary over mobilization

Learners Roles & Staging

Role Staging Info Given
1PT A few minutes into the scenario goes into patient room with walker, OT is currently in the room See FACILITATOR REPORT TO LEARNER
2OT Is in the room at the start of scenario and has completed an ADL treatment session with patient (ROM of UE) has completed an ADL treatment session with patient becomes a team member when PT enters the room

Confederate Roles & Scripting

RoleTone Timing of participation Lines / Comments
DaughterConcerned, anxious, somewhat cooperative

At bedside at start of scenario

When PT suggests it may not be today

When told she needs to be up and walking around before she goes home...:

"I am all set for my mom to go back to Haiti in the next few days"

"I was prepared for today. I will take care of her, she has a bed in my home, etc..."

"No, I can care for her in bed until her pain goes away"

SW Pleasant, but insistent about getting patient discharged tomorrow. Enters room after PT enters, PT and OT are confronted

"Oh great, I'm glad you're here. I just want to confirm the discharge plan to return home for Mrs. Paui.

Do you think she'll be able to receive rehab in Haiti? She's medically cleared, so we need to get her out tomorrow." Leaves abruptly...

Facilitator Report to Primary Learner to Start Scenario

Separately: to the OT: this is the third OT treatment session with Mrs. Paui, s/p TKR. you are covering for the OT who has worked with her the past 2 days, you will be responsible to determine if Mrs.Paui is ready to be discharged back to Haiti and that her UE ROM is WFL.

To the PT: Mrs. Paui in 516 had a total knee replacement, and was cleared for discharge back to Haiti. I did the eval 2 days ago and tried to see her yesterday, but she's been complaining of a lot of pain and would not cooperate to get out of bed or ambulate. Here's her chart, I think OT is in there now doing ADLs with her, you two figure out her discharge, I've got to run up to med-surg; thanks for covering."

Technician Staging Directions

Staged for Learners Available for Learners to Use
Manikin 75 year old
Race Haitian
Gender Female
Clothes Hospital Gown
Position Supine in bed with CPM running on R LE or Right knee ace wrapped with incision with steri-strips, bruising around knee.
Moulage ID band, Foley catheter to left side of the bed
Environment

In-patient hospital room

Daughter seated at bedside

Bedside table with glasses, book, incentive spirometer, water

Equipment

Normal headwall

CPM on R LE (if available)

walker
Disposable Supplies Extra hospital gown
IV Saline right arm with pole on right side of bed
Medications PCA analgesia in place on left side of the bed
Labs

On chart results

CBC WNL

PT/INR WNL

Type and screen

Xray
Other Diagnostics
Chart Records

Intake form

OR report

Anesthesia note

Lab results

Nursing notes

MD notes

Orders Page PT, OOB, WBAT R LE, OT ADLs for return home

OT and PT initial evaluation

Progression of Events

Time Manikin Actions Performance Measures Cues/Confederates
0-7 Minutes
Initial at 3 min
HR 120
Rhythm Sinus
RR 14
O2 Sat 98%
Breath Sounds Clear
B/P 130/80
Temperature 37.8
Bowel Sounds Normal
Mental Status A&O x 4

Tone: anxious, cooperative, but having pain and not wanting to participate in PT

Script: "I can't get out of bed. My knee is killing me. I don't think I can walk today. I know they want me to go back to Haiti, but I just don't think I'm ready. Rest is what I need until this pain goes away." I will move my arms only"

  1. Maintains professional behavior in verbal and nonverbal communication in all interactions
  2. Introduces self to patient, family, team members
  3. Sanitizes hands prior to patient contact
  4. Confirms patient identity by verbalizing name and checking wrist band
  5. Checks patient chart for PT orders (OOB, PT, WB Status)
  6. Conducts screening examination to ensure patient clear for participation in PT (VS, ROM, Pain, skin inspection
  7. Safely removes CPM or inspects bandaged knee
  8. Moves all lines to 1 side of the bed for safe patient transfer
8-15 Minutes
Initial During Transfer
HR 120 135
Rhythm Sinus Sinus
RR 14 18
O2 Sat 98% 98%
Breath Sounds Clear Clear
B/P 130/80 140/80
Temperature 37.8 37.8
Bowel Sounds Normal Normal
Mental Status A&O x 4 A&O x 4

Tone: Same

Script: "I need help getting up. My knee hurts me. I don't think I can walk today" 9. Sets up wheelchair or bedside chair, and ensures locks on both chair and bed prior to transfer

  1. Moves bedside table and any other furniture for safe transfer.
  2. PT identifies patient not safe for discharge to home
  3. OT reports that patient appears ready for DC
  4. SW enters and asks " is she ready to go?"
  5. PT and OT respond appropriately to questions regarding discharge disposition to daughter
  6. PT and OT attempt to sit patient at EOB

If/Then Chart

IF Cardiac Respiratory Diagnostic Other
1 PT does not recognize patient not stable for discharge home Daughter starts commenting that she doesn't think her mom will be safe alone at home and asking PT for advice
2 PT/OT not concerned about DC SW insists on a discharge plan

Integrated Debriefing Guide

Threads Performance Measures/Discussion Points Debriefing Prompt
Opening

Someone give us a quick summary of what was going on with this patient.

What went well?

What didn't go so well?

Understand clinical presentation

Conducts patient interview/history

Conducts screening examination to ensure patient clear for participation in PT (VS, ROM, Pain, skin inspection

What signs and symptoms could we expect for this type of patient (s/p TKR)?
Identify contributing factors PT/OT identify that culture may be playing a role in patient compliance to rehabilitation

Describe some contributing risk factors we should consider....

How does this patient's culture affect this encounter?

Recognize a change in patient status* PT identifies patient not safe for discharge to home

Looks/sounds like things are changing what is concerning at this point?

How do we involve the daughter and patient in the plan?

Identify correct intervention / treatment Checks patient chart for PT orders (OOB, PT, WB Status)

What are some standards of care for this type of patient?

What other options for care would be reasonable?

Understand cultural implications PT/OT determine that patients lack of participation is not just pain related after checking on medication administration

What thoughts do we have about how this patient's beliefs may impact outcomes?

How do we best address their beliefs?

Assessment* Conducts screening examination to ensure patient clear for participation in PT (VS, ROM, Pain, skin inspection

Thoughts about types of specific assessments that are important for this patient...

What are priorities for this patient?

Infection Control Sanitizes hands prior to patient contact What infection control practices would we need to consider?
Medication Administration* Identify the pain medication schedule and timing of the PT visit. What medications could be considered? In what order should they be given? How?
Patient Safety

Moves all lines to 1 side of the bed for safe patient transfer

Sets up wheelchair and ensures locks on both chair and bed prior to transfer

Talk about some concerns and options on how we could keep this patient safe...
Documentation What information would we want to document? What are strategies for doing that during a crisis?
Communication *

Introduces self to patient, family, team members

PT responds appropriately to questions regarding discharge disposition to both family and team members

What additional information would we like to have had from PT 1 who has been involved in the this patients care?

As a newcomer to the patient situation, what information would be helpful? What information should be relayed from OT to PT? from team to SW?

Let's practice giving an SBAR about this patient......

What are some strategies for handling difficult family members?

Situational Awareness*

PT identifies patient not safe for discharge to home

PT/ OT discuss possibilities for patient

Discuss some strategies to prevent us from becoming task focused....

What resources could be accessed for help?

Decision Making Prioritization*

PT/OT identifies patient not safe for discharge to home

PT/OT responds appropriately to questions regarding discharge disposition to both family and team members

How were decisions made?
Leadership* PT responds appropriately to questions regarding discharge disposition to both family and team members How were roles delegated? How was leadership established? What actions did the leader take to ensure situational awareness?
Professional Behavior* Maintains professional behavior in verbal and nonverbal communication in all interactions

How were we coming across?

What are some strategies for managing difficult interactions?

How well do we understand the roles of all OT, PT and SW?

Closing

What would we do differently next time?

Does anyone have any additional questions or comments?

* = typical event to stop/review with video replay

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