eSimulation in Action at Kettering Medical Center

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eSimulation in Action at Kettering Medical Center
Barbara Musgrave, RN, MSN, CPAN Kettering Health
Network Kettering, Ohio
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Kettering Medical Center

• Kettering Hospital 400-450 beds
• Sycamore Hospital 200 beds
• Kettering Behavior Medical Care 50 beds
• All part of the Kettering Health Network

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Objectives

• Describe the process of implementing a
  comprehensive online staff development process.
• Identify the barriers and advantages for online
  learning.
• Describe the evolving programs of esimulation for
  KMC.

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Goal

• Provide a
• cost effective,
• evidence-based,
• user friendly,
• easily accessible method for staff development
  and BLS training.

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The Past

• Kettering Hospital had 5-6 Education Days held
  from January to June.
• Education Days ran from 8am-3 pm until all
  nurses requirements were met.
• Daily attendance was between 200-250 nurses each
  quarter.

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The Past

• These were 8 hour days in which staff were
  scheduled to attend once a year.
• Because of space limitations, the Education
  Days were held in a rented space off the
  hospital campus.

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The Past

• All staff nurses attending were taken off the
  unit schedules or coming to the education days on
  their day off.
• Thus, patient care staffing was challenging for
  many units in addition to budgets for many
  managers.
• Lunch and break food items were catered in at an
  expense to the Professional Development
  Department.

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BLS

• Required eight to ten instructors each month
• Subjective view of pass and fail
• Transfer and storage of manikins costly and time
  consuming

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BLS Training

• 2250 staff required to maintain BLS competency
• 30 BLS course offerings
• 5 courses per month January June
• 80 students per course
• 14 BLS Instructors per course offering

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Why Online Classes

• Single location and distribution for all users
• Link resources to internal policies and
  reference material
• Easily updated
• Available to all users wherever Internet access
  is available
• Manager and administrator time less on monitoring
  training

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Why Online Classes

• Online allows nurses more time at the bedside
  than traditional methods of education
• Eliminates staffing problems
• Participants finish in less time than lectures
• Educational content is presented in a consistent
  manner

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Knowledge Based Learning
(Simpson, 2007)
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Online Learning

• Definition content presented via a computer over
  the Internet.
• Learners have control and responsibility.
• Large amount of content broken down into smaller
  modules.
• Easy transfer of new knowledge to skills used.

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Criteria For Selection of Software

• Easy Use
• Interactive characters
• Graphics
• Rapid Calculation
• Interest Level
• Content
• Adapted from Evalating Computer Assisted
  Instruction by Christnene Bolwell, 1989, New
  York National League for Nursing.

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What We Were Searching For

• One program for annual regulatory requirements
  and free CEs (replace annual education days)
• 1. BLS (competency and skills)
• 2. Diverse educational opportunities available
  online with CEs
• 3. Accessible from work or home 24/7
• 4. Up-to-date and evidence-based

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What We Were Searching For

• 5. Easily updated
• 6. Available to all users wherever Internet
  access is available
• 7. Manager and administrator time less on
  monitoring training

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HealthStream

• Compliance with Annual Regulatory Requirements
  for the Nursing Division
• Provides many free contact hours
• Facilitates competency evaluation
• Facilitates online BLS and ACLS course
• Provides educational support on diverse topics.

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HealthStream

• Interactive testing for instant feedback
• Announcement section for specific hospital news
  and alerts
• Access 24 hours a day from any computer

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BLS
Laerdal Medical Corporation
American Heart Association
HealthStream
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How Does It Work?

• Can take Part 1 at work or home
• Part 2 completed in BLS Lab
• Mailed BLS card in approximately 2 weeks.
  Completion of Class listed on online transcript

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Business Plan

• A Business Plan had to be presented to
  Administration

• Identifying needs of the facility
• Listing initial and long-term costs
• Calculating long-term savings to the healthcare
  system
• Recommending a system or systems

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The Process of Implementation

• Skill Labs
• 3 campuses
• 6 mannequin sets
• 4 dedicated computers
• Labs accessible 24/7
• Professional Development staff available
• Mon - Fri 0730 1800
• Sun 0630 1830 and 0930 2130 once monthly

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Yea!! I did it.
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How Are We Doing- BLS

• 84.2 rated 5/5 Educational needs met

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Staff Comments Regarding BLS

• Loved the computer feedback!
• Love this. It is more realistic.
• I love doing it this way! I feel like I am more
  prepared should I need to use my skills.
• This is wonderful. I love the hands on
  experience and how the computer lets you know how
  you are doing through the whole procedure.

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Staff Comments Regarding BLS

• Great and concise.
• I love it! Much better than class. I received
  precise feedback from the computer.
• I liked taking the test onlineand then applying
  it to the mannequin skills. It made it real.

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What Was Said (Nurses are not shy)

• Some of the skills needed were computer skills
  rather than BLS skills, thereby discriminating
  against those with poor computer skills
• Sometimes frustrating, but got through it none
  the less. It does give you correct technique
• I personally didn't like it. I prefer the old way.

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How Are We Doing- Skills Day

• Long Nursing Ed Days are gone
• Replaced with Skills Day- Check-off on
  Restraints and Mock Code only
• Offered two 12 hour weekdays monthly and one
  12-hour Sunday once a quarter.
• 95.7 evaluated 5 out of 5 on Individual
  educational needs being met

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Staff Comments of Skills Day

• Very concise and to the point. Nice experience.
• Great yearly reminders
• I prefer the old fashion way when we had
  education days. I dont like everything cut so
  short and on the computer
• Having this on the weekend is great!

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Courses
In last 12 months KHN employees have completed
22,607 courses with a total estimated hour time
of 18,276. 1,029 completions of BLS
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How Are We DoingOnline Classes

• Does the format meet your needs? 87.6
  rated 3 above out of 5
• Does the online learning format save you time?
  
  70.7 rated 3 above out of 5
• Were your educational needs met? 87.2 rated
  3 and above out of 5

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Cost Comparison
2007 Traditional BLS 2008 HeartCode BLS
Registered Nurse 354.38 Registered Nurse 41.00
Licensed Practical Nurse 322.00 Licensed Practical Nurse 41.00
Nursing Assistant 244.86 Nursing Assistant 41.00

Registered Nurse 556,376.60 Registered Nurse 64,370.00
Licensed Practical Nurse 58,604.00 Licensed Practical Nurse 10,742.00
Nursing Assistant 64,153.32 Nursing Assistant 7,462.00
Total Cost 679,133.92 Total Cost 82, 574.00
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The Final Numbers

• Savings 596,559.92
• Staffing solutions
• No need to schedule nurses off unit
• Staff coverage issues decreased
• Problem of hours not available for all shifts
  eliminated.
• Instructors
• Facility
• Equipment

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What Was Gained

• Empowerment and Self Governance
• Accessible 24/7
• Self scheduling
• Part 1 completed at home, nursing unit
• Part 2 drop in
• Interactive computer allows for immediate
  feedback
• Objective
• Enhanced skills

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Compliance with Education

• Managers notified weekly through emails and
  reports.
• CNO notified weekly of nursing staff advancing
  education through available courses.
• Collaboration between clinical and educational
  practice enhanced with easy computer access and
  results.

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Positives

• Preceptors access to grades.
• Transcripts organized by skill name, task name,
  or completion date.
• Provides easy access to a comprehensive resource
  for review of skills.
• Offers an interactive testing process to check
  for competency of skills.
• Increased knowledge and competency.

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Challenges

• Computer Knowledge
• Expectations of Performance
• Use Your Full Body Weight
• Compress A Little Deeper
• Word of Mouth (ie Bad News Travels Fast)

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Barriers

• Unsupportive managers
• Staff issues
• Availability of programs
• Family commitments
• Participation on own time
• Computer savvy

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Added Bonus

• Less than 14 successful resuscitation rate in
  2007
• 27 successful resuscitation rate in 2008
• 32 successful resuscitation rate for 2009
• Today I made a difference.

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Evolving

• ACLS availableWhere to go from here?

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ACLS 2008

• 50 licenses purchased for trial
• Users were staff nurses, medical residents, and
  clinical nurse managers
• Assessable in Professional Development Department
  only for Part 1 and Part 2
• All 50 licenses completed with passing rate

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Learning Needs

• 567 Nurses for recertification of ACLS in 2009
• KMC consists of KH, SH, and KBMC
• KH consists of 4 ICUs, 6 Med/Surg with full
  telemetry, 2 Med with partial telemetry, only one
  Meg/Surg without
• SH consists of 1 ICU and 3 Med/Surg with
  telemetry throughout facility
• KBMC consists of 1 adult and 1 youth unit

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The Past

• Quarterly ACLS class offered for primary ( 2-8
  hour days) and recertification (4-6 hours)
• Nurses scheduled off unit or on day off
• Limited availability in classes usually 20
  participant limit
• Difficult to schedule-few classes offered

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Past Costs

• 40 purchase for live class for each participant
• 4-5 instructors within the organization with
  EMTs from community
• Staff paid for hours of class
• Frequently overtime used for patient care on
  cardiac and ICU units for patient care coverage

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ACLS 2009

• Assessable from home or hospital
• Requires Internet access, no dial up
• No personal cost for nurses
• 12 free CEs upon completion
• 10 computers available in Professional
  Development for use for Part 1
• Part 1 obtainable 24/7 from home or work
• Part 2 for skills on site with mannequins
  available 730-1700

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ACLS 2009 Benefits

• No time waiting for available class
• Assignment for new hires instantly
• Over 30 days for completion of course
• HeartCode book online in program
• Participants can practice at their own rate
• No costs for instructors, nurses hours in class,
  patient care hours for coverage while at class

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Barriers

• Access from some users homes Computer
  literacy challenged for some staff nurses
• Hours of online class longer than time spent in
  classroom setting from the past program
• Poor Internet access in some homes

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2009 ACLS

• 319 courses assigned
• 77 completed
• 24.14

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Different learner types

• Visual primarily through written word
• Auditory-listening required, focuses on words
• Kinesthetic-learns by doing, practice and hands
  on opportunities work best
• 
  Notter, 2002

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Generational differences

• Traditionalists-written form is preference -5 of
  workforce
• Baby Boomers-loves meetings-45 of the workforce
• Generation X-video game pros, PCs-40 of the
  workforce
• Generation Y-grew on the Internet, e-mail,
  Facebook-10 of the workforce
• 
  Dittman, 2005

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KMC Gains

• Pass/Fail measurable
• Increase individual critical thinking skills
• Increases nurses computer skills
• Average age of nurses on all units 11 under 30
  y.o., 70 greater than 40 y.o.
• Objective grading vs. subjective
• 2008 ANA NDNQI
  RN Survey Report

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Evolving

• Essentials of Critical Care Orientation
• 64 Contact Hours
• Developed by the American Association of
  Critical-Care Nurses (AACN)
• Staff member has one year to complete
• 25 licenses purchased as trial phase

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Success of ECCO Program

• Overwhelming request for program- 20 nurses
• Completion of program in 12 months
• Certification rate for CCRN from participants

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Evolving.

• Pediatric Advanced Life Support Course
• Starting in Second Quarter 2009

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Evolving

• Classes have been bundled to target specific
  patient populations, ie Stroke, Cardiac
• Simulation mannequin to enhance BLS, ACLS, and
  ECCO programs
• More hands-on practice to promote critical
  thinking skills

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Questions?

• Contact Barbara Musgrave at Barbara. Musgrave
  _at_khnetwork.org
• 937.298.3399 ext. 57342