Wednesday, September 10, 2014

How to use an EHR no matter what type of simulation experience your students have

When we talk to Simulation Lab Coordinators and Instructors, we've come across all sorts of setups. We've met High-Fidelity Sim Lab Coordinators, Nursing Instructors who use the old school, low-tech mannequins and instructors of new programs who are using a combination of virtual, paper and volunteer patients. Not only have we talked to each type of school, but we have all varieties of instructors and schools using EHR Tutor in effective, interesting ways. So just because your school does things a little bit different, doesn't mean your students can't benefit from the latest technology. Here's how:

Have a High Fidelity Sim Lab? We've found that schools with cutting edge mannequins usually have comparatively extensive resources surrounding their lab (for example, a viewing room for students to watch a simulation happen, recording technology to visually review and discuss the simulation afterwards, etc.). If your school is lucky enough to fall into this group, this is a great chance to use an Academic EHR system to mimic exactly how students would chart in real life throughout the simulation. Before beginning the simulation, make sure the patient chart is set up to match the beginning of the scenario (meaning the patients' age, weight, orders and initial assessment should match any initial information the student would have at the beginning of the simulation). Have students open that chart at a bedside computer or tablet. As the simulation goes, make sure students are charting things as they progress or immediately after an intervention. This is a great way to talk about appropriate timing for charting. Is the student correctly prioritizing care vs. charting? Are they neglecting a procedure to record information or are they neglecting charting between procedures when given a chance? Is there any information they forgot to record in the heat of the moment or did they keep their heads in the computer so often they forgot to notice the patient's vital signs dropping? This is also a great way to discuss work flow, collaboration and orders. When the patient needs a medication, did the student "call in" to the physician (i.e. the instructor) and ask for an order to be entered? When the Instructor entered the order, did the student check the details and dosage in the orders section, which would be visible immediately considering everything shows up in real time? During the process, students are constantly learning what information they need from other staff members in a clinical setting and looking for that information in the appropriate places. That way, students won't feel as lost when left on their own in the field. They'll know where to look for information and who to go to when they don't have that information available.

Have Old School Mannequins?  Just because your mannequins don't carry the simulation themselves, doesn't mean you can't use an EHR to give just as great an experience to your students as the more advanced sim labs. Instead of using an Academic EHR as a supplemental charting tool, this is when the EHR system can really drive the simulation. Because EHR Tutor is web-based, everything a student or instructor enters will show up in real time. With that in mind, you can create a "Shared Patient" (meaning that students can see each other's work on that particular activity) and have the instructor drive the simulation by logging in to his/her computer and also working on the patient throughout the simulation. For example, have students open up a chart that is completed with vital signs, orders and an initial assessment that match the beginning of the scenario. As the student reviews the orders (for example, check vital signs every 4 hours and give Morphine as needed), they'll start to do the work as they see fit. The orders are a great way to set up a scenario - what is it that the students will be doing today? They should be comfortable reviewing written orders and acting accordingly instead of relying on someone verbally explaining all items the student will be responsible for (just like real life!). An instructor can then change the patient's information as the simulation progresses. For example, do you want the student to see that oxygen levels are falling fast? Right after a student takes the vital signs of the patient, an instructor can also enter vital signs from her own computer, showing a quick drop in oxygen levels from one entry to the next. The student should compare those levels, notice the difference, and take appropriate actions (for example, check to see if there is an order for oxygen or, depending on the situation, call the doctor). You can also discuss things like allergies and interactions with medications. Are the students checking allergies before giving a med? If not, as an instructor you can change the chart to display all the symptoms of anaphylaxis. Do you students recognize what is happening when you remind them to review the chart before moving forward? Do they take appropriate steps? Charting in this case is not just about documentation, it's about information and research for the students. An EHR is how they get their information, how they make decisions and how they review what's happening with the patient. Then they can document.

Have Virtual Patients? If your school is using a virtual patient, this one is a no-brainer. Most virtual patients come with a pre-set scenario. However, not all virtual patients have a charting feature. In this case, an Academic EHR is great charting practice, but also a key review tool. This gives instructors a way to review student work after students go through the virtual patient scenario, grade that work accordingly and even use that work as an example of what to do - or not to do! - in class. If you're only using specific aspects of virtual patients like a video to set up a scenario or link to a recording of breathe sounds, an Academic EHR is the glue that can hold all those parts together. For example, you might want to put all of the links to various resources in the instructions for the activity and then have students chart accordingly in EHR Tutor. That way, the charting is the background of the activity and the videos, sounds, online resources are just supplements to the chart.

Have People Patients? Lastly, for those of you working with volunteers, an EHR system can finally help keep those volunteers on track. They no longer have to remember EVERY symptom, because your students can review the initial chart for assessments, orders, etc. on that volunteer patient. Once the simulation starts with your volunteer, many of the ways to use an Academic EHR with volunteers will be similar to how you would use it with a High Fidelity Sim Lab. This is a great way to practice workflow and charting. Are the students properly reviewing and recording information or are they getting lost in the patient? Does their workflow make sense in terms of when they are charting? This is a great way to test those skills, and also to review their work afterwards.