Using Simulation to Teach Hospital Quality Improvement Measures

Submitter Information

Author: Kathy Spade,
Title: Nursing Simulation/Lab Coordinator
Institution: Waket Technical Community College

Competency Category(s)
Quality Improvement, Safety, Teamwork and Collaboration

Learner Level(s)
Pre-Licensure ADN/Diploma

Learner Setting(s)
Skills or Simulation Laboratories

Strategy Type
General Strategy

Learning Objectives

This teaching strategy is designed to
evaluate the following KSA’s:

1. Knowledge: Recognize that nursing and
other health professions students are parts of systems of care and care
processes that affect outcomes for patients and families.

2. Skills: Use tools to make processes of
care explicit.

3. Attitudes: Appreciate that continuous
quality improvement is an essential part of the daily work of all health

Strategy Overview

Student nurses should be taught hospital
quality improvement efforts while in nursing school. This will help them to
better understand the focus of quality care as they enter the hospital setting.
The Institute for Healthcare Improvement has developed an Improvement Map for hospitals.
This map also serves as a great resource for the development of simulation
scenarios that include evidence-based interventions. Many of our patients are
elderly. The Improvement Map gives interventions for “Essential Care of
Frail Older Patients”. These interventions were incorporated into a
simulation for an elderly patient with a fractured hip who develops delirium.

The following elements from this IHI map were

1. Implement standard processes to assess
frail older patients on admission to the hospital (Falls Risk, Polypharmacy,
Beers Criteria, Mental Status Assessment).

2. Consider following and putting into place
appropriate screening and interventions when necessary for a comprehensive
approach to minimizing risk in older patients (CAM assessment for delirium,
PAINAD scale for delirium).

3. Consider asking, “What is the
greatest hazard that this patient faces?” and establish a prevention and
treatment program to address the hazard upon each admission. (In this simulation,
the patient develops delirium and the physician orders restraints. Discussion
takes place as the student has to use TeamStepps- Advocacy and Assertion to
question the order. This leads to discussion of prevention of delirium in this
high risk population).

Submitted Materials

Additional Materials

Evaluation Description

This workshop was funded by a 2012 Perkins
Grant. Faculty participated in the simulation and had the opportunity to
evaluate this teaching strategy. All acknowledged that teaching quality
improvement measures during simulation is important and will ease the
transition of our students to the workplace.

Students also participated in this simulation
and completed a formative evaluation. All students had a better understanding
of the standard processes used to assess the frail elderly on admission to the
hospital. All used appropriate screening and interventions during simulation to
provide a comprehensive approach to minimizing risk to this population of
hospitalized patients. Students gained a better understanding of prevention and
treatment of delirium in hospitalized frail elderly patients. Many students
lacked the opportunity to work with elderly patients experiencing
post-operative delirium and stated that this simulation was valuable.

Faculty choosing to use this teaching
strategy can use their own formative evaluation tool. It is best to administer
this immediately after the debriefing session. Many include questions related
to effectiveness of the debriefing session if this is a new teaching strategy
for them.