Chad Epps

Capnography enhances surveillance of respiratory events during procedural sedation: a meta-analysis.

STUDY OBJECTIVE To determine if capnography, in addition to standard monitoring, identified more respiratory complications than standard monitoring alone. DESIGN Meta-analysis. SETTING University medical center. MEASUREMENTS The electronic databases PubMed, CINAHL, and Cochrane Library (Cochrane Reviews, CENTRAL) were searched for studies published between 1995-2009 reporting adverse respiratory events during procedural sedation and analgesia (PSA) with clearly defined end-tidal carbon dioxide threshold, adult population, clear study design, P-value calculation, similar outcome and predictor variable definitions, and binary independent and dependent variable raw data. Five such studies were evaluated independently. A meta-analysis of these studies was performed. MAIN RESULTS During PSA, cases of respiratory depression were 17.6 times more likely to be detected if monitored by capnography than cases not monitored by capnography (95% CI, 2.5-122.1; P < 0.004). CONCLUSION End-tidal carbon dioxide monitoring is an important addition in detecting respiratory depression during PSA.

A history of simulation-enhanced interprofessional education

Abstract This article explores the evolution and history of interprofessional education (IPE) using healthcare simulation (HCS). The evolution described here demonstrates an achievement of patient safety efforts as a consequence of the historical roots of healthcare and highlights HCS as a progressive method synergistic with IPE. This paper presents a descriptive review that covers the HCS and IPE literature, indicating factors that led to the use of HCS in IPE. Understanding the history of simulation-enhanced IPE provides healthcare educators with fertile ground to support future IPE. A number of benefits in using HCS to address common challenges to IPE are outlined, including natural relevance and engagement for learners, faculty attraction to its use, and the opportunity to explore socio-historical issues in teams. Several promising directions for future research are suggested.

The Genetic Basis of Addiction

Addiction is a complex disease infl uenced by genetic, environmental, developmental, and social factors. Once viewed as a moral weakness in character, substance use disorders are now defi ned as maladaptive patterns of substance use leading to inability to control use despite signifi cant consequences in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) [ 1 ]. Family, adoption, and twin studies support the importance of biologic factors and prompted the search for an inherited link. Because addiction is a heterogeneous and complex disorder without a clear Mendelian pattern, identifi cation of specifi c genes has proved challenging.

Mannequin Based Simulators

Manikin-based simulators represent the predominant form of technology used in healthcare simulation. This technology includes a spectrum from partial-task trainers to full-scale, high-fidelity manikins. Full-scale manikins have variability in their control mechanisms and in their autonomous features. Various commercially available platforms allow for significant variability in the delivery of simulations by an operator for a learner. Manikin-based simulators also have significant feature variability. Respiratory, cardiovascular, and neurologic signs and symptoms are available. In addition, pharmacologic and procedural capabilities are available in varying degrees. This chapter includes a summary of manikins across the age and cost spectrum and several tables which compare features and other specifics. Task trainers have been developed for airway management, invasive procedures, skills-based teaching and learning and other special situations, primarily surgical. There is ongoing innovation in task trainer development around the world. Future direction for manikin-based simulators will likely include continued specialization in age-related specifications and advanced functionality.

Simulation Faculty Development: A Tiered Approach

Summary Statement Simulation faculty development has become a high priority for the past couple of years because simulation programs have rapidly expanded in health systems and universities worldwide. A formalized, structured model for developing quality facilitators of simulation is helpful to support and sustain this continued growth in the field of simulation. In this article, we present a tiered faculty development plan that has been implemented at a university in the United States and includes the essentials of faculty development. We discuss the rationale and benefits of a tiered faculty development program as well as describe our certification plan. The article concludes with lessons learned throughout the process of implementation.

The genetic basis of addiction and relevant cellular mechanisms.

Classical genetic research approaches to determining the genetic contribution to a multifactorial condition have been used to quantify the proportion of addiction and substance abuse that is a result of heritable genetic factors versus environmental factors. Family studies, twin studies, and adoptio

Board #257 - Program Innovation Who Do You Call When Things Get Complicated? Simulations for Health Administration, Medicine and Nursing Students (Submission #8949)

Objectives Hospital administrators are individuals that provide oversight and leadership within healthcare organizations. In the current and future healthcare environment, it is increasingly important for hospital administrators to understand the roles of all disciplines and to understand how to effectively communicate with key stakeholders. To be successful, hospital administrators must work collaboratively with physician leaders, clinical and non-clinical professional staff, and external constituents, such as Board members. The goal of this case was to expose Masters’ of Science in Health Administration students to clinical scenarios they will potentially face in the future. By using simulated cases, the goal is for students to have the opportunity to interact with members of the healthcare team including physicians, nurses, respiratory therapists, patients and families. The MSHA students were integrated into an existing interprofessional student curriculum which included nursing, medical and respiratory therapy students. Description This study took place in the Pediatric Simulation Center located at Children’s of Alabama and the Simulation Center located at the University of Alabama at Birmingham Hospital, both of which are located in Birmingham, Alabama. There were three simulated cases used that included exposure to the following situations: 1) A DNR/DNI patient whose family member insisted on intubation against the patient’s wishes after the patient became unconscious; 2) A pediatric patient, whose parent was a Jehovah’s witness, that desperately needed blood after experiencing inflected head trauma; and 3) A medical error involving a patient who was given 100 units of insulin instead of 10 units. Data were collected using program evaluations completed immediately at the conclusion of each simulation experience by the participating health administration students. Evaluations were collected from a total of 18 health administration students. Each evaluation contained statements about the simulation experience with the options of agree, neutral, or disagree. Participants were also asked to describe what they believed was most beneficial about the experience and what they feel could be improved. Conclusion All of the participants felt that their simulation experience was a valuable learning experience and the majority of participants felt that the experience will improve their care of patients in the future. Many of the students commented that these cases also helped them realize how important it is to have interdisciplinary communication and collaboration. Simulations were the most valuable to MSHA students when there were defined questions relating to legal issues because these cases had higher engagement of administrators. When asked about improvements, the recurring themes included clarification of the role of the administrator in the case, as well as having an actual administrator in the debriefing session following each simulation who could provide clearer answers as to proper ways to deal with each situation. Seventeen of the 18 students agreed that they would recommend this case series to others and several commented that having more than one opportunity to participate in simulations would be beneficial. Reference l. Cooper JB, Singer SJ, Hayes J, Sales M, Vogt JW, Raemer D, Meyer GS. Design and evaluation of simulation scenarios for a program introducing patient safety, teamwork, safety leadership, and simulation to healthcare leaders and managers. Simul Healthc 2011 Aug;6(4):231-8. Disclosures None

Board 115 - Program Innovations Abstract An Interprofessional Intensive Care - Laboratory Science, Medicine, Nursing and Respiratory Therapy Students and Trainees (Submission #560)

Introduction/Background The value of interprofessional simulation is increasingly being documented. Our group sought to develop a multi-patient, multi-professional extended simulation session for laboratory science, medicine, nursing and respiratory therapy participants. The intent of the simulation was to challenge learners with significant complexity to allow for critical thinking, prioritization and team-based communication challenges. We created a very difficult afternoon in the intensive care unit (ICU) setting. Methods A multi-professional team including laboratory sciences, medicine, nursing and respiratory therapy developed a four patient ICU based extended time simulation experience. Patient profiles were created by the simulation team. A timeline and set of expected actions was carefully crafted. The patient record was created and included nursing documentation on ICU based flow sheet as well as timed laboratory results. The patients that were in the mock ICU included a recent transfer from the floor with presumed septic shock who develops a transfusion related lung injury reaction, an expected new admit from the emergency department with chronic obstructive pulmonary disease who needs bipap, a patient who recently received a tracheostomy and who is weaning off the respirator and a recent transfer from the floor with respiratory distress who is currently being evaluated for a pulmonary embolus. The nursing students arrived before the other learners and received check out from confederate nurses who were going off shift and had time to complete their assessments. The respiratory participants were briefed about available equipment and respiratory plan of care. Seven nurses, four laboratory students, two medical residents, one medical student and three respiratory therapy students participated in the simulation. Over 15 faculty members and confederates were present to assist with scenario flow, manikins management and debriefing. The entire scenario lasted 75 minutes and the debriefing was completed in stages, with a portion at the bedside, a portion with the entire group and additional discipline specific debriefing. Evaluation data included general evaluation which was solicited both in writing and in the form of a focus group. Participants were overwhelmingly positive about the experience. They highlighted the opportunity to practice the care of patients with other healthcare team members. Nursing students in particular had suggestions for improving the fidelity of the situation. Faculty involved provided feedback for future sessions. The faculty after action review focused on both discipline specific improvements, as well as overall opportunities for clarification. For example, for nursing and respiratory requested standardization of medications and supplies in a format that is more consistent with an actual ICU setting. The physicians reported that the fact that they were needed in many locations added to the realism but would have preferred to have the standard checkout sheet that they use in actual practice. Laboratory science students, who were located off site, would prefer to be closer to the action. Conclusion To our knowledge, this represents the first collaboration of these four disciplines in a multi-patient simulation scenario focusing on prioritization of multiple patients. The activity was well received; however, the quality of the simulation experience was likely related to the high proportion of faculty to students. Additional work is needed to streamline this educational effort to allow for widespread implementation. Reference ©1. Scherer et al. Interprofessional Simulation to Foster Collaboration between Nursing and Medical Students Clinical Simulation in Nursing (2013) e1-e9. Disclosures None.