MEERKATS 2 MK 2 facilitator guide€¦ · 0800 - 0830 Registration, pre-course questionnaire, meet mannequin OBSERVATION ROOM Learners should arrive by 0815 and should sign the register

FACILITATOR HANDBOOK

MEERKATS 2 2012

© Greg McAnulty, Phil Newman, Nick Gosling, Vaughan Holm, Hasmita Bagia, Deborah Dawson. 2012! Version 1.0.2Page 1

COURSE AIMSThe MEERKATS programme is a series of courses designed to highlight the principles of patient safety in the context of acute patient care. The major components are:

• ASIRT (acute serious illness recognition and treatment - an ABCDE approach to initial management of an acutely unwell patient on the ward)

• EWS (an introduction to the early warning system for ward patient monitoring)

• SBAR (situation, background, assessment, recommendation - structured system of communication)

• Human Factors and Patient Safety (the study of how individuals and teams interact with systems and how this affects patients)

There are 3 different individual courses:

• iMEERKATS: an introduction to the key concepts for nursing induction• MEERKATS 1: for ward nurses who are or are about to become shift leaders• MEERKATS 2: for F1 doctors and senior ward nurses

MEERKATS 2 is multi-professional and is designed to have real acute care teams learning together. It involves a series of ‘workshops’ based on common clinical problems and patient safety concepts interspersed with high-fidelity simulation scenarios. It lasts one day and requires a minimum of two faculty and one technician to run.

MEERKATS 2 2012


PROGRAMME

0800 - 0830Registration, pre-course questionnaire, meet mannequin

OBSERVATION ROOM [Page 4]Registration, pre-course questionnaire, meet mannequin

OBSERVATION ROOM [Page 4]

0830 - 0930Aims of the day, ASIRT

OBSERVATION ROOM [Page 4]Aims of the day, ASIRT


0930 - 1015EWS, SBAR

OBSERVATION ROOM [Page 4]EWS, SBAR


1015 - 1045Workshop 1 (Cardiovascular)

OBSERVATION ROOM [Page 5]Human factors

DEBRIEF ROOM 1 [Page 6]

1045 - 1115Scenario 1

SIMULATION LAB [Page 8]Workshop 1 (Cardiovascular)

OBSERVATION ROOM [Page 9]1115 - 1130 CoffeeCoffee

1130 - 1200Workshop 2 (Respiratory)

OBSERVATION ROOM [Page 10]Scenario 1

SIMULATION LAB [Page 10]

1200 - 1230Scenario 2

SIMULATION LAB [Page 11]Workshop 2 (Respiratory)


1230 - 1300Human factors


SIMULATION LAB [Page 14]

1300 - 1330 LunchLunch

1330 - 1400Workshop 3 (Metabolic)

OBSERVATION ROOM [Page 15]Pain

DEBRIEF ROOM 1 [Page 16]

1400 - 1430Scenario 3

SIMULATION LAB [Page 18]Workshop 3 (Metabolic)


1430 - 1500Workshop 4 (CNS, capacity)


SIMULATION LAB [Page 20]1500 - 1515 CoffeeCoffee

1515 - 1545Scenario 4

SIMULATION LAB [Page 21]Workshop 4 (CNS, capacity)


1545 - 1615Pain


SIMULATION LAB [Page 24]1615 - 1630 Conclusions & post-course evaluation OBSERVATION ROOM [Page 25]Conclusions & post-course evaluation OBSERVATION ROOM [Page 25]

MEERKATS 2 2012


0800 - 0830 Registration, pre-course questionnaire, meet mannequin

OBSERVATION ROOM

Learners should arrive by 0815 and should sign the register and fill in the pre-course questionnaire. At 0820 (sharp) bring everyone into Sim room 1 where they will be introduced (briefly) to the mannequin and simulator environment. The facilitator for the simulation scenarios will remain in the room, so it is not necessary for the introduction to be too detailed. Make sure the ‘meet the mannequin’ session concentrates on going through airway (voice), breathing (chest movement and breath sounds), circulation (pulses, BP, info about cap refill, IV access and giving fluids), neuro (pupils, AVPU, blood glucose info, temp), urine output, abdominal examination, the monitor and brief information about where fluids and giving sets are kept. Explain that during the scenarios if there are any problems they can just ask.

Be ready to start the first session by at the latest 0840. Collect the pre-course questionnaires and allocate the learners into 4 groups: A1, A2, B1, B2. Each group should have 1 F1 and 2 nurses but there will be variations. Try to avoid having groups of just nurses or with too many doctors. If nurses come from the same ward, try to keep them together. All stay in the Observation Room for:

0830 - 0930 Aims of the day, ASIRT

OBSERVATION ROOM

SLIDES: SECTION 1 (AIMS AND ASIRT). MATERIALS: ABCD/E CARDS

The aim of this session is to briefly outline the procedure for the day, to state the overall aims of MEERKATS and to refresh the learners’ understanding of ABCDE assessment. You should ensure that they do most of the talking. Make sure they know where the exits are, how to find the toilet (they will need to take a pass to get back in) and when lunch is (1300 - 1330) . The day should finish at about 1630.

When you get to the first slide of ASIRT divide the learners into their 4 groups (ask them to sit together). Give one of the ABCD/E cards to each of the groups and explain that the group with the appropriate card will lead the discussion on each of the ABCD/E sections.

All stay in the Observation Room for the next session.

0930 - 1015 EWS, SBAR

OBSERVATION ROOM

MEERKATS 2 2012


SLIDES: SECTION 2 (EWS AND SBAR). MATERIALS: EWS EXERCISE CARDS AND EWS FORMS, SBAR PADS, PATIENT DETAILS (3.1) SCRIPTS (3.2, 3.3, 3.4).

This is an interactive session done in the same small groups in two parts. The first is a calculation of SBAR done in groups of 3. Hand out the EWS forms, one to each group. Make sure at least one member of each group has used them. Point out that the F1s may not be entirely familiar with the form and ask the nurses in the groups to take them through it.

Hand out the patient details sheets and ask each group to calculate the EWS and specify what action should be taken. Get the groups to present the answers to each other.

For SBAR pick one F1 and one nurse and ask them to stand up one each side of the room. Hand the SBAR (part 1) scripts to them and ask them to act them out. Ask each group to use an SBAR form to write out a better SBAR communication and get some or all the groups to act them out. Point out that the SHO should do some ‘active listening’ (confirming, clarifying, etc rather than just listening passively). If necessary, get another pair to stand up and act out the ideal SBAR from the scripts (part 2).

At 1015 the group splits into two: A and B. Group A stays in the Observation Room for the first workshop. Group B go to Debrief Room 1 for Human Factors.

1015 - 1045 Workshop 1 (Cardiovascular) Human factors

Workshop 1 (Cardiovascular)

GROUP A OBSERVATION ROOM

SLIDES: WORKSHOP 1 (CVS)

MATERIALS: CVS EXERCISE CARDS (4.1), PAPER, PENS

This workshop covers common cardiovascular problems on the wards. Divide the group up in to 2 groups of 3. HAND OUT THE EXERCISE CARDS AND A4 PAPER, PENS.

Ask each group to look at the patient story and discuss the questions amongst themselves. After 5 minutes bring both groups back together an go through the questions in turn encouraging the learners to expand and clarify the issues.

It is important that the learners themselves do most of the talking during the workshop. Use the slides as reminders of topics for discussion. The speakers notes give lists of points to cover. There are 4 slides which describe the circulatory changes for different types of shock and the response to a fluid challenge in hypovolaemia.

The main learning objectives for this section are:

MEERKATS 2 2012


• hypotension and tachycardia are generally associated with inadequate organ perfusion

• the causes of this should be considered (in particular, under the headings of hypovolaemic, cardiogenic, septic)

• a fluid challenge is a diagnostic test for hypovolaemia (and will be positive where increasing the preload of the LV leads to an increased cardiac output)

• if a fluid challenge is negative, there is no point in just giving more and more fluid. Help is needed!

At 1045 this group go to the Simulation Lab for Scenario 1.

Human factors

GROUP B DEBRIEF ROOM 1

SLIDES: SECTION 3 (HUMAN FACTORS).

This section is designed to (re-) familiarise the learners with the key terms used in describing how people interact with complex systems: ‘Human Factors’.

SLIDE NOTES:

SLIDE 2

WE DELIVER HEALTHCARE TO OUR PATIENTS IN TEAMS. NONE OF US CAN DO MUCH ON OUR OWN. THIS IS AN EXAMPLE OF A TEAM. WHAT ARE THE DIFFERENCES BETWEEN THESE PEOPLE AND US?

TRY TO BRING OUT: LOTS OF PEOPLE DEDICATED TO A SINGLE TASK (BUT COMPARE TO AN OPERATING THEATRE) REHEARSAL VERY SPECIFIC ROLES PUBLIC HUMILIATION WITH FAILURE TO PERFORM SITTING ON THE CHAIRS BEHIND IF NOT PERFORMING THIS TASK NICE UNIFORMS, TOBACCO CO SPONSORSHIP, ETC SLIDE 3

STUDY OF 100 CONSECUTIVE ADMISSIONS TO IN SOUTHAMPTON AND PORTSMOUTH ASSESSED AS TO WHETHER THEY RECEIVED OPTIMAL VS SUB-OPTIMAL TREATMENT BEFORE ADMISSION. JUST OVER HALF DEEMED AS ‘SUB-OPTIMAL’, JUST UNDER A QUARTER ‘OPTIMAL’ AND JUST OVER A QUARTER WERE DISPUTED (EXCLUDED FROM THIS CHART). 56% MORTALITY IN THE SUB-OPTIMAL GROUP, 35% IN THE OPTIMAL GROUP. NO DIFFERENCE BETWEEN THE GROUPS AT HOSPITAL ADMISSION.

SLIDE 4

ARE YOU FAMILIAR WITH THESE TERMS? WHAT DO THEY MEAN.

MEERKATS 2 2012


GET THOSE WHO KNOW WHAT THEY MEAN TO TELL THE OTHERS IN THE GROUP.

THEY COME FROM DESCRIBING HOW PEOPLE WORK IN ‘HIGH-RELIABILITY ORGANISATIONS’

SLIDE 5

REPORTED ACCIDENT RATES HAVE IMPROVED IN MOST HROS. NOT IN SHIPPING AND NOT IN HEALTHCARE.

WHY? (ASK THE GROUP TO SPECULATE)

SLIDE 6

CAPTAIN FRANCESCO SCHETTINO ON THE BRIDGE OF THE COSTA CONCORDIA. WHAT ABOUT THE HIERARCHY HERE? COULD THIS HAVE CONTRIBUTED TO THE ACCIDENT?SLIDE 8IS IT REALLY DOWN TO AN INDIVIDUAL?

SLIDE 9

FILM: IF ONLY...

SLIDE 11

COMMON THINGS RECORDED ON BLACK BOX JUST BEFORE DISASTER. ARE THESE FAMILIAR TO YOU?

SLIDE 12

12 COMMUNICATION AND BEHAVIOUR PHENOMENON WHICH MAY INDICATE AN ERROR CHAIN IS EVOLVING.

FAMILIAR?

WHAT CAN WE DO IF WE THINK WE ARE HEADING FOR A DISASTER.

SLIDE 13

CHECK LISTS ARE ONE WAY OF AVOIDING LOSS OF SITUATIONAL AWARENESS.

SLIDE 14

HUMAN FACTORS. NORMALLY ASSOCIATED WITH EXCITING FIELDS OF WORK AND ‘CRISES’. IN FACT, JUST AS IMPORTANT IN THIS SLOWLY DEVELOPING DISASTER...

SLIDE 15

MEERKATS 2 2012


ONE OF THE PROBLEMS WE HAVE IN HOSPITALS IS THAT WE WORK IN AD HOC TEAMS. SPECIFICALLY, SITUATIONAL AWARENESS...

SLIDE 16

MILITARY DEFINITION OF SITUATIONAL AWARENESS

OR, MORE SIMPLY...

SLIDE 20

SOMETIMES THINGS ARE ONLY TOO PREDICTABLE BUT THOSE INVOLVED JUST COULDN’T SEE IT.

[NEXT SLIDE] HAVE A LOOK AT THIS. WHAT’S HAPPENED, WHAT’S HAPPENING. WHAT MIGHT HAPPEN?

SLIDE 22

PERHAPS WE CAN USE THIS MODEL TO HELP US ASSESS THE RISK OF SOMETHING GOING WRONG. IF ALL YOUR BUCKETS ARE FULL: DON’T DO IT![NEXT SLIDE]LET’S GO BACK TO THE MAN WITH HIS HEAD IN THE ALLIGATOR’S MOUTH.

At 1045 this group go to the Observation Room for Workshop 1.

1045 - 1115 Scenario 1 Workshop 1 (Cardiovascular)

Scenario 1

GROUP A SIMULATION LAB.

MATERIALS: PATIENT NOTES, DRUG CHART, LAMINATED OBS SHEETS. NEW BLANK EWS SHEETS, SBAR PAD.

The theme of this scenario is hypovolaemia. Divide the group into 3 participants and 3 observers. Everyone (including the facilitator) stays in the room. Particularly for this first scenario, take the participants through each step of the initial ABCDE assessment and subsequent management. Don’t be afraid to stop, rewind, take time out or to go over particular points. Try to involve the observers in the discussion as much as possible.

You should divide the time into:

Introduction 3 min 1045 - 1048ABCDE (and EWS) 12 min 1048 - 1100Case summary 5 min 1100 - 1105Action plan 5 min 1105 - 1110

MEERKATS 2 2012


SBAR 5 min 1110 - 1115

Encourage the team to write down observations and use the SBAR form.

AT 1115 ALL GO TO COFFEE

Workshop 1 (Cardiovascular)

GROUP B OBSERVATION ROOM

SLIDES: WORKSHOP 1 (CVS)

MATERIALS: CVS EXERCISE CARDS (4.1), PAPER, PENS

This workshop covers common cardiovascular problems on the wards. Divide the group up in to 2 groups of 3. HAND OUT THE EXERCISE CARDS AND A4 PAPER, PENS.


It is important that the learners themselves do most of the talking during the workshop. Use the slides as reminders of topics for discussion. The speakers notes give lists of points to cover. There are 4 slides which describe the circulatory changes for different types of shock and the response to a fluid challenge in hypovolaemia.


• hypotension and tachycardia are generally associated with inadequate organ perfusion

• the causes of this should be considered (in particular, under the headings of hypovolaemic, cardiogenic, septic)

• a fluid challenge is a diagnostic test for hypovolaemia (and will be positive where increasing the preload of the LV leads to an increased cardiac output)

• if a fluid challenge is negative, there is no point in just giving more and more fluid. Help is needed!


AT 1115 ALL GO TO COFFEE

1115 - 1130 Coffee

1130 - 1200 Workshop 2 (Respiratory) Scenario 1

MEERKATS 2 2012


Workshop 2 (Respiratory)

GROUP A OBSERVATION ROOM

SLIDES: WORKSHOP 2 (RESP)

MATERIALS: RESP EXERCISE CARDS (5.1) PAPER, PENS, MANNEQUIN HEAD, BAG/VALVE/MASK, AIRWAYS, O2 MASKS, EXAMINATION COUCH OR TROLLEY, FLIP CHART.

This workshop covers common respiratory problems on the wards. Divide the group up in to 2 groups of 3. HAND OUT THE EXERCISE CARDS AND A4 PAPER, PENS.


It is important that the learners themselves do most of the talking during the workshop. Use the slides as reminders of topics for discussion. The speakers notes give lists of points to cover. The concept of shunt may be difficult for some. Try to get those in the group who say they understand it to explain it to the others.


• Acutely hypoxic patients need oxygen.• SpO2 should be monitored early• If a patient is not breathing adequately he/she needs help• The causes for hypoxia should be thought of in terms of causes for shunt.• Acute dyspnoea should prompt an urgent investigation of the cause


Scenario 1

GROUP B SIMULATION ROOM


The theme of this scenario is hypovolaemia. Divide the group into 3 participants and 3 observers. Everyone (including the facilitator) stays in the room. Particularly for this first scenario, take the participants through each step of the initial ABCDE assessment and subsequent management. Don’t be afraid to stop, rewind, take time out or to go over particular points. Try to involve the observers in the discussion as much as possible.


Introduction 3 min 1130 - 1133ABCDE (and EWS) 12 min 1133 - 1145

MEERKATS 2 2012


Case summary 5 min 1145 - 1150Action plan 5 min 1150 - 1155SBAR 5 min 1155 - 1200



1200 - 1230 Scenario 2 Workshop 2 (Respiratory)

Scenario 2

GROUP A SIMULATION ROOM 1200 - 1230


The theme of this scenario is respiratory failure. Divide the group into 3 participants and 3 observers. Everyone (including the facilitator) stays in the room. Take the participants through each step of the initial ABCDE assessment and subsequent management. Don’t be afraid to stop, rewind, take time out or to go over particular points. Try to involve the observers in the discussion as much as possible.


Introduction 3 min 1200 - 1203ABCDE (and EWS) 12 min 1203 - 1215Case summary 5 min 1215 - 1220Action plan 5 min 1220 - 1225SBAR 5 min 1225 - 1230


At 1230 this group stay go to the OBSERVATION ROOM for Human Factors.

Workshop 2 (Respiratory)

GROUP B OBSERVATION ROOM 1200 - 1230

SLIDES: WORKSHOP 2 (RESP)


This workshop covers common respiratory problems on the wards. Divide the group up in to 2 groups of 3. HAND OUT THE EXERCISE CARDS AND A4 PAPER, PENS.

MEERKATS 2 2012





• Acutely hypoxic patients need oxygen.• SpO2 should be monitored early• If a patient is not breathing adequately he/she needs help• The causes for hypoxia should be thought of in terms of causes for shunt.• Acute dyspnoea should prompt an urgent investigation of the cause


1230 - 1300 Human factors Scenario 2

Human factors

GROUP A DEBRIEF ROOM 1 1230 - 1300

SLIDES: SECTION 3 (HUMAN FACTORS).

This section is designed to (re-) familiarise the learners with the key terms used in describing how people interact with complex systems: ‘Human Factors’.

SLIDE NOTES:

SLIDE 2

WE DELIVER HEALTHCARE TO OUR PATIENTS IN TEAMS. NONE OF US CAN DO MUCH ON OUR OWN. THIS IS AN EXAMPLE OF A TEAM. WHAT ARE THE DIFFERENCES BETWEEN THESE PEOPLE AND US?

TRY TO BRING OUT: LOTS OF PEOPLE DEDICATED TO A SINGLE TASK (BUT COMPARE TO AN OPERATING THEATRE) REHEARSAL VERY SPECIFIC ROLES PUBLIC HUMILIATION WITH FAILURE TO PERFORM SITTING ON THE CHAIRS BEHIND IF NOT PERFORMING THIS TASK NICE UNIFORMS, TOBACCO CO SPONSORSHIP, ETC

MEERKATS 2 2012


SLIDE 3

STUDY OF 100 CONSECUTIVE ADMISSIONS TO IN SOUTHAMPTON AND PORTSMOUTH ASSESSED AS TO WHETHER THEY RECEIVED OPTIMAL VS SUB-OPTIMAL TREATMENT BEFORE ADMISSION. JUST OVER HALF DEEMED AS ‘SUB-OPTIMAL’, JUST UNDER A QUARTER ‘OPTIMAL’ AND JUST OVER A QUARTER WERE DISPUTED (EXCLUDED FROM THIS CHART). 56% MORTALITY IN THE SUB-OPTIMAL GROUP, 35% IN THE OPTIMAL GROUP. NO DIFFERENCE BETWEEN THE GROUPS AT HOSPITAL ADMISSION.

SLIDE 4

ARE YOU FAMILIAR WITH THESE TERMS? WHAT DO THEY MEAN.

GET THOSE WHO KNOW WHAT THEY MEAN TO TELL THE OTHERS IN THE GROUP.

THEY COME FROM DESCRIBING HOW PEOPLE WORK IN ‘HIGH-RELIABILITY ORGANISATIONS’

SLIDE 5

REPORTED ACCIDENT RATES HAVE IMPROVED IN MOST HROS. NOT IN SHIPPING AND NOT IN HEALTHCARE.

WHY? (ASK THE GROUP TO SPECULATE)

SLIDE 6

CAPTAIN FRANCESCO SCHETTINO ON THE BRIDGE OF THE COSTA CONCORDIA. WHAT ABOUT THE HIERARCHY HERE? COULD THIS HAVE CONTRIBUTED TO THE ACCIDENT?SLIDE 8IS IT REALLY DOWN TO AN INDIVIDUAL?

SLIDE 9

FILM: IF ONLY...

SLIDE 11

COMMON THINGS RECORDED ON BLACK BOX JUST BEFORE DISASTER. ARE THESE FAMILIAR TO YOU?

SLIDE 12

12 COMMUNICATION AND BEHAVIOUR PHENOMENON WHICH MAY INDICATE AN ERROR CHAIN IS EVOLVING.

FAMILIAR?

WHAT CAN WE DO IF WE THINK WE ARE HEADING FOR A DISASTER.

MEERKATS 2 2012


SLIDE 13

CHECK LISTS ARE ONE WAY OF AVOIDING LOSS OF SITUATIONAL AWARENESS.

SLIDE 14

HUMAN FACTORS. NORMALLY ASSOCIATED WITH EXCITING FIELDS OF WORK AND ‘CRISES’. IN FACT, JUST AS IMPORTANT IN THIS SLOWLY DEVELOPING DISASTER...

SLIDE 15

ONE OF THE PROBLEMS WE HAVE IN HOSPITALS IS THAT WE WORK IN AD HOC TEAMS. SPECIFICALLY, SITUATIONAL AWARENESS...

SLIDE 16

MILITARY DEFINITION OF SITUATIONAL AWARENESS

OR, MORE SIMPLY...

SLIDE 20

SOMETIMES THINGS ARE ONLY TOO PREDICTABLE BUT THOSE INVOLVED JUST COULDN’T SEE IT.

[NEXT SLIDE] HAVE A LOOK AT THIS. WHAT’S HAPPENED, WHAT’S HAPPENING. WHAT MIGHT HAPPEN?

SLIDE 22

PERHAPS WE CAN USE THIS MODEL TO HELP US ASSESS THE RISK OF SOMETHING GOING WRONG. IF ALL YOUR BUCKETS ARE FULL: DON’T DO IT![NEXT SLIDE]LET’S GO BACK TO THE MAN WITH HIS HEAD IN THE ALLIGATOR’S MOUTH.

At 1300 all go to LUNCH.

Scenario 2

GROUP B SIMULATION ROOM 1230 - 1300


The theme of this scenario is respiratory failure. Divide the group into 3 participants and 3 observers. Everyone (including the facilitator) stays in the room. Take the participants through each step of the initial ABCDE assessment and subsequent management. Don’t

MEERKATS 2 2012


be afraid to stop, rewind, take time out or to go over particular points. Try to involve the observers in the discussion as much as possible.




At 1300 all go to LUNCH.

1300 - 1330 Lunch

1330 - 1400 Workshop 3 (Metabolic) Pain

Workshop 3 (Metabolic)

GROUP A OBSERVATION ROOM 1330 - 1400

SLIDES: WORKSHOP 3 (METABOLIC)


This workshop covers problems with glycaemic control, urine output, electrolyte and acid-base disturbances on the wards. Divide the group up in to 2 groups of 3. HAND OUT THE EXERCISE CARDS AND A4 PAPER, PENS.




• Understand the difference between type 1 and 2 diabetes and the implications

MEERKATS 2 2012


• Be familiar with the problems of managing diabetes in hospital• To have a logical approach to oliguria• Outline the main issues for managing patients with electrolyte and acid-base

abnormalities.


Pain

GROUP B DEBRIEF ROOM 1 1330 - 1400

SLIDES: SECTION 7 (PAIN).

This section is designed to (re-) familiarise the learners with the key issues in managing acute pain on the wards.

SLIDE 2 ANALGESIC STAIRCASE

ADDITIVECONSIDER REGULAR ADMINISTRATION

SLIDE 3 SAFETY

(USE FLIP CHART)

WHAT ARE THE PROBLEMS ASSOCIATED WITH NOT GIVING ADEQUATE PAIN RELIEF?

HUMANITARIAN COMPLIANCE CHEST INFECTIONS PHYSIO

WHAT COMPLICATIONS ARE ASSOCIATED WITH ANALGESICS?

NAUSEA AND VOMITING GI BLEEDING OTHER BLEEDING RESPIRATORY DEPRESSION CONSTIPATION CARDIOVASCULAR

SLIDE 4 STEP 1

(USE FLIP CHART)

REGULAR PARACETAMOL

+/- REGULAR IBUPROFEN

MEERKATS 2 2012


SLIDE 5 STEP 2

(USE FLIP CHART)

WEAK OPIOID OR REGULAR NSAID

CODEINE PHOSPHATE / DIHYDROCODEINE / ORAL MORPHINE OR DICLOFENAC

PLUS LOCAL BLOCKS, ETC (ANAESTHETIST / ACUTE PAIN TEAM)

SLIDE 6 STEP 3

(USE FLIP CHART)

STRONG OPIOID

PARENTERAL MORPHINE / MORPHINE PCA

SLIDE 7 OPOID SIDE EFFECTS AND OVERDOSE

(USE FLIP CHART)

SIDE EFFECTS OF OPIOIDS

CONSTIPATION CONFUSION / DYSPHORIA NAUSEA AND VOMITING

WHAT CAN YOU DO ABOUT THEM?

WHY MIGHT A PATIENT BE MORE LIKELY TO BE SENSITIVE TO OPIOIDS? (NB CONSIDER DRUGS NOT USUALLY THOUGHT TO BE A PROBLEM (CODEINE, OPIOIDS IN COMBINATIONS)

SMALL, FRAIL, ELDERLY LIVER / RENAL FAILURE INDIVIDUAL VARIATION METHOD OF ADMINISTRATION (REGULAR RATHER THAN PRN) TYPE OF DRUG (MORPHINE VS OXYCODONE)

WHAT CAN HAPPEN?WHAT IS THE TREATMENT?

SLIDE 8 NALOXONE

DOSE

MEERKATS 2 2012


HALF LIFE

SLIDE 9 NAUSEA AND VOMITING

(USE FLIP CHART)

CAUSES DRUGS BOWEL OBSTRUCTION / ILEUS OPOIDS SEPSIS DKA

MANAGEMENT HYDRATION ALTERNATIVE ANALGESIA NUTRITION (NB DIABETICS) INVESTIGATE GI TRACT? ANTIEMETICS WHAT WORKS? (GET NURSES TO TALK ABOUT THIS) PROBLEMS (DYSTONIC REACTIONS)


1400 - 1430 Scenario 3 Workshop 3 (Metabolic)

Scenario 3



The theme of this scenario is the management of hyperosmolar, hyperglycaemic state. Divide the group into 3 participants and 3 observers. Everyone (including the facilitator) stays in the room. Make sure that they go through an ABCDE assessment and subsequent management. Don’t be afraid to stop, rewind, take time out or to go over particular points. Try to involve the observers in the discussion as much as possible.



MEERKATS 2 2012



At 1430 this group go to the Observation Room for WORKSHOP 4.

Workshop 3 (Metabolic)


SLIDES: WORKSHOP 3 (METABOLIC)


This workshop covers problems with glycaemic control, urine output, electrolyte and acid-base disturbances on the wards. Divide the group up in to 2 groups of 3. HAND OUT THE EXERCISE CARDS AND A4 PAPER, PENS.




• Understand the difference between type 1 and 2 diabetes and the implications

• Be familiar with the problems of managing diabetes in hospital• To have a logical approach to oliguria• Outline the main issues for managing patients with electrolyte and acid-base

abnormalities.


1430 - 1500 Workshop 4 (CNS, capacity) Scenario 3

Workshop 4 (CNS, capacity)


SLIDES: WORKSHOP 4 (CNS)

MEERKATS 2 2012


MATERIALS: CNS EXERCISE CARD (7.1) PAPER, PENS, FLIP CHART.

This workshop covers common neurological problems on the ward. Divide the group up in to 2 groups of 3. HAND OUT THE EXERCISE CARDS AND A4 PAPER, PENS.




• The realisation that problems with the airway and breathing are immediate complications of neurological emergencies on the wards.

• Dealing with confused patients who may be a danger to themselves or others involves an assessment of capacity

• Management of seizures on the ward requires attention to ABCDE

At 1500 all go to COFFEE.

Scenario 3



The theme of this scenario is the management of hyperosmolar, hyperglycaemic state. Divide the group into 3 participants and 3 observers. Everyone (including the facilitator) stays in the room. Make sure that they go through an ABCDE assessment and subsequent management. Don’t be afraid to stop, rewind, take time out or to go over particular points. Try to involve the observers in the discussion as much as possible.




At 1500 all go to COFFEE.

MEERKATS 2 2012


1500 - 1515 Coffee

After COFFEE Group A go to the Simulation Lab for SCENARIO 4, Group B go to the OBSERVATION ROOM for WORKSHOP 4.

1515 - 1545 Scenario 4 Workshop 4 (CNS, capacity)

Scenario 4



The theme of this scenario is the management of an acutely confused patient. Divide the group into 3 participants and 3 observers. The observers will watch from the CONTROL ROOM.



It is likely that this scenario will run on a bit and no real conclusion is come to. Use the last 5 - 10 minutes of the allotted time to discuss the assessment of capacity and consequences of deciding that a patient does not have capacity and is at risk of harming him/herself or others.

At 1545 this group goes to the OBSERVATION ROOM for the session on PAIN.

Workshop 4 (CNS, capacity)


SLIDES: WORKSHOP 4 (CNS)

MATERIALS: CNS EXERCISE CARD (7.1) PAPER, PENS, FLIP CHART.

This workshop covers common neurological problems on the ward. Divide the group up in to 2 groups of 3. HAND OUT THE EXERCISE CARDS AND A4 PAPER, PENS.

MEERKATS 2 2012





• The realisation that problems with the airway and breathing are immediate complications of neurological emergencies on the wards.

• Dealing with confused patients who may be a danger to themselves or others involves an assessment of capacity

• Management of seizures on the ward requires attention to ABCDE

At 1545 this group go to the SIMULATION ROOM for SCENARIO 4.

1545 - 1615 Pain Scenario 4

Pain


SLIDES: SECTION 7 (PAIN).

This section is designed to (re-) familiarise the learners with the key issues in managing acute pain on the wards.

SLIDE 2 ANALGESIC STAIRCASE

ADDITIVECONSIDER REGULAR ADMINISTRATION

SLIDE 3 SAFETY

(USE FLIP CHART)

WHAT ARE THE PROBLEMS ASSOCIATED WITH NOT GIVING ADEQUATE PAIN RELIEF?

HUMANITARIAN COMPLIANCE CHEST INFECTIONS PHYSIO

MEERKATS 2 2012


WHAT COMPLICATIONS ARE ASSOCIATED WITH ANALGESICS?

NAUSEA AND VOMITING GI BLEEDING OTHER BLEEDING RESPIRATORY DEPRESSION CONSTIPATION CARDIOVASCULAR

SLIDE 4 STEP 1

(USE FLIP CHART)

REGULAR PARACETAMOL

+/- REGULAR IBUPROFEN

SLIDE 5 STEP 2

(USE FLIP CHART)

WEAK OPIOID OR REGULAR NSAID

CODEINE PHOSPHATE / DIHYDROCODEINE / ORAL MORPHINE OR DICLOFENAC

PLUS LOCAL BLOCKS, ETC (ANAESTHETIST / ACUTE PAIN TEAM)

SLIDE 6 STEP 3

(USE FLIP CHART)

STRONG OPIOID

PARENTERAL MORPHINE / MORPHINE PCA

SLIDE 7 OPOID SIDE EFFECTS AND OVERDOSE

(USE FLIP CHART)

SIDE EFFECTS OF OPIOIDS

CONSTIPATION CONFUSION / DYSPHORIA NAUSEA AND VOMITING

WHAT CAN YOU DO ABOUT THEM?

MEERKATS 2 2012


WHY MIGHT A PATIENT BE MORE LIKELY TO BE SENSITIVE TO OPIOIDS? (NB CONSIDER DRUGS NOT USUALLY THOUGHT TO BE A PROBLEM (CODEINE, OPIOIDS IN COMBINATIONS)

SMALL, FRAIL, ELDERLY LIVER / RENAL FAILURE INDIVIDUAL VARIATION METHOD OF ADMINISTRATION (REGULAR RATHER THAN PRN) TYPE OF DRUG (MORPHINE VS OXYCODONE)

WHAT CAN HAPPEN?WHAT IS THE TREATMENT?

SLIDE 8 NALOXONE

DOSEHALF LIFE

SLIDE 9 NAUSEA AND VOMITING

(USE FLIP CHART)

CAUSES DRUGS BOWEL OBSTRUCTION / ILEUS OPOIDS SEPSIS DKA

MANAGEMENT HYDRATION ALTERNATIVE ANALGESIA NUTRITION (NB DIABETICS) INVESTIGATE GI TRACT? ANTIEMETICS WHAT WORKS? (GET NURSES TO TALK ABOUT THIS) PROBLEMS (DYSTONIC REACTIONS)

At 1615 this group stays in the OBSERVATION ROOM for the CONCLUSION.

Scenario 4



MEERKATS 2 2012


The theme of this scenario is the management of an acutely confused patient. Divide the group into 3 participants and 3 observers. The observers will watch from the CONTROL ROOM.



It is likely that this scenario will run on a bit and no real conclusion is come to. Use the last 5 - 10 minutes of the allotted time to discuss the assessment of capacity and consequences of deciding that a patient does not have capacity and is at risk of harming him/herself or others.

At 1615 all go to the OBSERVATION ROOM for the CONCLUSION.

1615 - 1630 Conclusions and post-course evaluation

Ensure that each learner fills in an EVALUATION FORM. Once this is done CERTIFICATES can be handed out. Ask the group if there are any other things they would like to discuss.

MEERKATS 2 2012


Documents

MEERKATS 2 MK 2 facilitator guide€¦ · 0800 - 0830 Registration, pre-course questionnaire, meet mannequin OBSERVATION ROOM Learners should arrive by 0815 and should sign the register