1 00:00:09,420 --> 00:00:10,803 [Marge] Hello, everybody. 2 00:00:12,420 --> 00:00:13,920 I know that, 3 00:00:13,920 --> 00:00:15,390 can you guys hear me? 4 00:00:15,390 --> 00:00:16,223 Yes. 5 00:00:16,223 --> 00:00:17,310 Yeah, we can hear you. 6 00:00:17,310 --> 00:00:18,143 Hi. 7 00:00:18,143 --> 00:00:20,370 [Marge] I am sure that you guys were all ready to go, 8 00:00:20,370 --> 00:00:24,000 but I feel the need to introduce, 9 00:00:24,000 --> 00:00:26,283 well, everybody knows Julie Parent, 10 00:00:27,690 --> 00:00:30,570 and so it's lovely to have her here, 11 00:00:30,570 --> 00:00:33,240 since Sam insisted on taking time 12 00:00:33,240 --> 00:00:35,370 to spend with her new baby, I don't know why. 13 00:00:35,370 --> 00:00:38,280 Soon that should be waiting though. 14 00:00:38,280 --> 00:00:42,287 And but I know a lot of you know, 15 00:00:42,287 --> 00:00:47,287 Amelie Thurson, our nurse educator, 16 00:00:47,730 --> 00:00:51,960 she's the one that put the awesome drill books together. 17 00:00:51,960 --> 00:00:54,570 And then you might not know, but should know Wendy Conway, 18 00:00:54,570 --> 00:00:58,830 who is one of the OBGYNs in our practice, 19 00:00:58,830 --> 00:01:00,380 she's now the head of our QA&I, 20 00:01:01,680 --> 00:01:03,180 she's our night hospitalist, 21 00:01:03,180 --> 00:01:05,730 she is a great wealth of information. 22 00:01:05,730 --> 00:01:09,120 She has a special interest in simulation, 23 00:01:09,120 --> 00:01:11,700 and has worked with Kelly and Amelie 24 00:01:11,700 --> 00:01:15,450 in terms of rolling out the Insight to Drills, 25 00:01:15,450 --> 00:01:17,400 or whatever it is that you wanna call them. 26 00:01:17,400 --> 00:01:21,840 So, I just wanna thank them so much for doing this, 27 00:01:21,840 --> 00:01:24,840 and I am happy to turn it over. 28 00:01:24,840 --> 00:01:25,673 Thanks. 29 00:01:27,690 --> 00:01:28,653 Thanks, Marge. 30 00:01:30,150 --> 00:01:33,270 All right so, good to get going, Julie? 31 00:01:33,270 --> 00:01:34,103 Yeah. 32 00:01:34,103 --> 00:01:35,370 All right. 33 00:01:35,370 --> 00:01:38,100 Thank you guys for joining us today. 34 00:01:38,100 --> 00:01:40,860 As Marge said, we're gonna talk about the drill books 35 00:01:40,860 --> 00:01:44,133 that we've developed over the last year or so. 36 00:01:46,230 --> 00:01:49,830 I presented the drill books at the Nequin Conference, 37 00:01:49,830 --> 00:01:51,180 and there was a lot of interest 38 00:01:51,180 --> 00:01:53,460 in having a little bit more like detailed explanation 39 00:01:53,460 --> 00:01:55,740 of how we really like implemented it, 40 00:01:55,740 --> 00:01:57,660 and how we run them on the floor. 41 00:01:57,660 --> 00:01:59,700 So Wendy and I are here today 42 00:01:59,700 --> 00:02:02,370 to talk to you guys about how we've tackled this 43 00:02:02,370 --> 00:02:03,903 at UVM Medical Center. 44 00:02:06,090 --> 00:02:08,913 We have no disclosures to share with you all. 45 00:02:11,280 --> 00:02:12,480 Wendy's gonna introduce herself. 46 00:02:12,480 --> 00:02:14,310 I'll just briefly, as Marge said, 47 00:02:14,310 --> 00:02:17,400 I'm the Nurse Educator on Labor and Delivery here at UVM. 48 00:02:17,400 --> 00:02:20,460 I've worked in this role for the past five years, 49 00:02:20,460 --> 00:02:21,900 and was a staff nurse on the floor 50 00:02:21,900 --> 00:02:24,540 for 10 years prior to that, 51 00:02:24,540 --> 00:02:26,880 and definitely did not have a lot of experience 52 00:02:26,880 --> 00:02:28,230 with simulations and drills 53 00:02:28,230 --> 00:02:29,670 when I stepped into the educator role, 54 00:02:29,670 --> 00:02:32,400 and very quickly felt like I was like, 55 00:02:32,400 --> 00:02:34,020 a little in over my head. 56 00:02:34,020 --> 00:02:39,020 But luckily have had a lot of opportunities for training 57 00:02:39,690 --> 00:02:41,140 while I've been in this role. 58 00:02:43,290 --> 00:02:45,000 Hi, I'm Wendy Conway. 59 00:02:45,000 --> 00:02:46,860 I was asked to jump in on this, 60 00:02:46,860 --> 00:02:49,980 just mainly because of the experience I have 61 00:02:49,980 --> 00:02:51,180 with simulation. 62 00:02:51,180 --> 00:02:52,920 But I, like Marge said, 63 00:02:52,920 --> 00:02:54,570 I'm a generalist and a hospitalist 64 00:02:54,570 --> 00:02:58,050 that works now at the University of Vermont Medical Center. 65 00:02:58,050 --> 00:03:01,287 After I left, I actually did my training at UVM in OBGYN, 66 00:03:01,287 --> 00:03:03,360 and then left, and was a veteran, 67 00:03:03,360 --> 00:03:06,030 and served on active duty for the Air Force 68 00:03:06,030 --> 00:03:08,250 and was stationed in Japan, 69 00:03:08,250 --> 00:03:11,400 on a very small military base where I learned a lot, 70 00:03:11,400 --> 00:03:15,630 and then was sent to a very large overseas military base 71 00:03:15,630 --> 00:03:18,990 in Germany, called Landstuhl Regional Medical Center. 72 00:03:18,990 --> 00:03:22,080 And we were the only level one trauma at that time, 73 00:03:22,080 --> 00:03:22,950 certified, 74 00:03:22,950 --> 00:03:25,770 and we were the Obstetrical Regional Transport Center 75 00:03:25,770 --> 00:03:26,603 for Europe. 76 00:03:27,720 --> 00:03:28,650 I also have experience 77 00:03:28,650 --> 00:03:31,290 working in a lot of smaller hospitals throughout Vermont. 78 00:03:31,290 --> 00:03:33,390 I did not immediately work for 79 00:03:33,390 --> 00:03:36,938 the University of Vermont Medical Center when I came back, 80 00:03:36,938 --> 00:03:39,090 when I was finished with my active duty, 81 00:03:39,090 --> 00:03:40,530 my military commitment. 82 00:03:40,530 --> 00:03:42,030 So I do have a lot of experience, 83 00:03:42,030 --> 00:03:45,660 and kind of know what it's like to be in a small hospital 84 00:03:45,660 --> 00:03:49,260 with much more limited resources. 85 00:03:49,260 --> 00:03:50,100 And most recently, 86 00:03:50,100 --> 00:03:52,680 I started working with Society for Maternal Fetal Medicine, 87 00:03:52,680 --> 00:03:55,290 they have a Critical Care and Obstetrics course, 88 00:03:55,290 --> 00:03:56,430 which I highly recommend 89 00:03:56,430 --> 00:03:58,950 if you're interested in doing any kind of simulation, 90 00:03:58,950 --> 00:04:00,333 it's a great conference. 91 00:04:01,290 --> 00:04:04,620 In Arizona, they have an entire hospital 92 00:04:04,620 --> 00:04:06,780 dedicated to just simulation, 93 00:04:06,780 --> 00:04:09,300 and there's a course that we run there 94 00:04:09,300 --> 00:04:10,620 that runs through several things. 95 00:04:10,620 --> 00:04:13,710 But I'm specifically trained by them to be a debriefer, 96 00:04:13,710 --> 00:04:16,860 so my role isn't to necessarily run the simulation, 97 00:04:16,860 --> 00:04:19,320 it's more to talk about what happened during the simulation, 98 00:04:19,320 --> 00:04:20,153 how everyone's feeling about it, 99 00:04:20,153 --> 00:04:21,660 and get people to talk about it, and open it up, 100 00:04:21,660 --> 00:04:23,670 and make it as non-threatening as possible. 101 00:04:23,670 --> 00:04:25,830 And I really want sim to be 102 00:04:25,830 --> 00:04:27,120 really non-threatening for everyone, 103 00:04:27,120 --> 00:04:28,950 because I think the more you do things, 104 00:04:28,950 --> 00:04:29,783 the more you think about things, 105 00:04:29,783 --> 00:04:31,560 and the less threatened you are, 106 00:04:31,560 --> 00:04:33,870 and unafraid to ask questions, 107 00:04:33,870 --> 00:04:36,670 because every facility location, everything's different, 108 00:04:37,620 --> 00:04:41,460 it will only improve patient care. 109 00:04:41,460 --> 00:04:42,293 But thank you. 110 00:04:44,490 --> 00:04:46,980 So I'm just gonna talk, just like super high level, 111 00:04:46,980 --> 00:04:48,960 very brief overview of what AIM is, 112 00:04:48,960 --> 00:04:52,260 in case some of you are not familiar. 113 00:04:52,260 --> 00:04:54,660 AIM is the Alliance for Innovation on Maternal Health, 114 00:04:54,660 --> 00:04:57,690 and so this is like a national organization 115 00:04:57,690 --> 00:05:01,620 that carries out its work on the state-based level. 116 00:05:01,620 --> 00:05:03,120 It's a quality improvement initiative 117 00:05:03,120 --> 00:05:05,970 to support best practices and make birth safer, 118 00:05:05,970 --> 00:05:07,680 improved maternal health outcomes, 119 00:05:07,680 --> 00:05:09,453 and ultimately, save lives. 120 00:05:11,640 --> 00:05:16,230 So as I said, it says you implement these AIM initiatives 121 00:05:16,230 --> 00:05:17,733 on a state level. 122 00:05:18,600 --> 00:05:23,600 So, based on a review of like our hospital's data, 123 00:05:24,180 --> 00:05:26,880 and requirements also from the Joint Commission, 124 00:05:26,880 --> 00:05:29,160 UVM Medical Center chose to focus on the 125 00:05:29,160 --> 00:05:32,310 Hypertension Obstetric Hemorrhage Patient Safety Bundles, 126 00:05:32,310 --> 00:05:34,440 and AIM creates the bundle for you. 127 00:05:34,440 --> 00:05:38,370 So it's a really, really excellent program to work with, 128 00:05:38,370 --> 00:05:40,650 because there's no recreating the wheel, 129 00:05:40,650 --> 00:05:44,220 all of the resources that you need are on their website, 130 00:05:44,220 --> 00:05:46,890 and like very, very user-friendly. 131 00:05:46,890 --> 00:05:47,723 So, you know, 132 00:05:49,200 --> 00:05:51,000 there's lots of different patient safety bundles 133 00:05:51,000 --> 00:05:53,400 that are available, and I'll show you some of those. 134 00:05:53,400 --> 00:05:55,260 But we focused on these, 135 00:05:55,260 --> 00:05:57,420 because the Joint Commission has a requirement 136 00:05:57,420 --> 00:05:59,400 that all staff and providers 137 00:05:59,400 --> 00:06:01,290 that take care of pregnant patients 138 00:06:01,290 --> 00:06:05,520 are doing annual education on hypertension and hemorrhage. 139 00:06:05,520 --> 00:06:08,790 And then also, our data reflected that these were areas 140 00:06:08,790 --> 00:06:12,780 that would be beneficial for us to focus on too. 141 00:06:12,780 --> 00:06:16,860 So, right now, those are the two topics 142 00:06:16,860 --> 00:06:18,483 that our drill books focus on. 143 00:06:19,560 --> 00:06:22,020 I think that every hospital, 144 00:06:22,020 --> 00:06:24,510 every hospital now has a copy of our drill binders, 145 00:06:24,510 --> 00:06:26,430 but that doesn't mean you have to start 146 00:06:26,430 --> 00:06:27,450 with those two topics. 147 00:06:27,450 --> 00:06:28,620 You know, if there's other things 148 00:06:28,620 --> 00:06:31,230 that feel more pressing in your environment, 149 00:06:31,230 --> 00:06:33,960 then, by all means, start with the bundles 150 00:06:33,960 --> 00:06:37,323 that feel the most applicable for you. 151 00:06:39,030 --> 00:06:43,740 These are the current AIM safety bundles that are available 152 00:06:43,740 --> 00:06:45,423 on the AIM website. 153 00:06:47,910 --> 00:06:49,410 And once you're on the website, 154 00:06:49,410 --> 00:06:51,150 kind of like click into each one of these, 155 00:06:51,150 --> 00:06:53,100 and it opens up the whole bundle. 156 00:06:53,100 --> 00:06:55,700 But these are the ones that are currently available. 157 00:06:56,820 --> 00:07:00,393 I think they're always working on creating new ones. 158 00:07:01,380 --> 00:07:03,330 So like for example, if you click into 159 00:07:03,330 --> 00:07:06,240 the Obstetric Hemorrhage Patient Safety Bundle, 160 00:07:06,240 --> 00:07:08,010 this is what you'll find. 161 00:07:08,010 --> 00:07:10,920 So, each bundle is broken down into these categories, 162 00:07:10,920 --> 00:07:12,930 these five categories of Readiness, 163 00:07:12,930 --> 00:07:14,760 Recognition and Prevention, 164 00:07:14,760 --> 00:07:17,400 Response, Reporting and Systems Learning, 165 00:07:17,400 --> 00:07:20,340 and then a new section 166 00:07:20,340 --> 00:07:22,380 that is now part of every patient's safety bundle 167 00:07:22,380 --> 00:07:25,236 is this Respectful, Equitable and Supportive Care 168 00:07:25,236 --> 00:07:26,643 for patients. 169 00:07:28,410 --> 00:07:31,470 And then like once you click into each one of these links, 170 00:07:31,470 --> 00:07:33,630 there's more and more information on like, 171 00:07:33,630 --> 00:07:36,180 how to prepare, how to be ready, 172 00:07:36,180 --> 00:07:37,710 how to recognize and prevent, 173 00:07:37,710 --> 00:07:38,913 what's your response. 174 00:07:40,110 --> 00:07:44,670 So it's really nice, 'cause it gives you just a template, 175 00:07:44,670 --> 00:07:46,680 and then you can modify things 176 00:07:46,680 --> 00:07:48,750 for your specific environment, 177 00:07:48,750 --> 00:07:51,750 obviously, depending on the type of hospital that you're at, 178 00:07:52,740 --> 00:07:54,570 some things may not be applicable 179 00:07:54,570 --> 00:07:57,033 or need to be adapted for your practice area. 180 00:07:58,470 --> 00:08:00,960 This is great, 'cause you don't have to reinvent anything, 181 00:08:00,960 --> 00:08:03,540 it's just, print it out and figure out what you wanna use. 182 00:08:03,540 --> 00:08:05,910 So it shouldn't be a lot of work. 183 00:08:05,910 --> 00:08:08,643 And then if you have the binders, 184 00:08:09,870 --> 00:08:10,980 we kind of went through, 185 00:08:10,980 --> 00:08:13,410 and like the binders there, 186 00:08:13,410 --> 00:08:14,870 it gives you an example of what we use 187 00:08:14,870 --> 00:08:16,530 at UVM Medical Center, 188 00:08:16,530 --> 00:08:18,060 and then it also gives you the example 189 00:08:18,060 --> 00:08:19,500 of the one that AIM provides. 190 00:08:19,500 --> 00:08:22,650 So you can kind of see how AIM lays it out for you, 191 00:08:22,650 --> 00:08:26,100 and then you can see how we adapted it for our environment, 192 00:08:26,100 --> 00:08:28,470 and then you can make, you know, similar changes 193 00:08:28,470 --> 00:08:29,620 based on what you need. 194 00:08:31,380 --> 00:08:35,040 So I think a really important step upfront 195 00:08:35,040 --> 00:08:37,800 before you, you know, even try to launch this, 196 00:08:37,800 --> 00:08:39,840 is to make sure that you have 197 00:08:39,840 --> 00:08:42,330 institutional support and buy-in 198 00:08:42,330 --> 00:08:44,403 from the leaders in your area. 199 00:08:48,424 --> 00:08:51,930 It's pretty hard to embed this into the culture on a unit 200 00:08:51,930 --> 00:08:54,270 if it's not what you have previously done. 201 00:08:54,270 --> 00:08:56,400 And then that becomes even more difficult 202 00:08:56,400 --> 00:08:59,430 if you don't have support from your leadership. 203 00:08:59,430 --> 00:09:02,343 So those conversations should kind of start there. 204 00:09:03,510 --> 00:09:04,698 You know, 205 00:09:04,698 --> 00:09:09,150 are we in support of not down staffing 206 00:09:09,150 --> 00:09:13,230 to keep staff on the unit to run drills? 207 00:09:13,230 --> 00:09:17,550 Are we in support of scheduling simulation events 208 00:09:17,550 --> 00:09:20,550 and activities outside of patient care hours? 209 00:09:20,550 --> 00:09:21,383 That kind of stuff. 210 00:09:21,383 --> 00:09:23,760 So those are important conversations to have. 211 00:09:23,760 --> 00:09:25,770 And then from there, 212 00:09:25,770 --> 00:09:27,360 you need to have the conversations of 213 00:09:27,360 --> 00:09:30,182 who's initiating drills, 214 00:09:30,182 --> 00:09:31,860 who runs the drill, 215 00:09:31,860 --> 00:09:33,450 who actually is facilitating, 216 00:09:33,450 --> 00:09:35,490 and who's tracking them. 217 00:09:35,490 --> 00:09:37,230 That might be all one person, 218 00:09:37,230 --> 00:09:39,930 and it might all be separate people. 219 00:09:39,930 --> 00:09:43,050 Again, it depends on like the size of your team, 220 00:09:43,050 --> 00:09:44,490 who is available, 221 00:09:44,490 --> 00:09:47,253 and just how like the workflow will work best for you. 222 00:09:52,590 --> 00:09:55,800 So if you are one of the people 223 00:09:55,800 --> 00:09:58,380 who's going to be facilitating the drills, 224 00:09:58,380 --> 00:10:01,080 I think the most important step, really, 225 00:10:01,080 --> 00:10:03,420 is that you feel prepared 226 00:10:03,420 --> 00:10:05,570 before you start running drills with staff. 227 00:10:07,050 --> 00:10:09,450 Familiarize yourself with the resource binder, 228 00:10:09,450 --> 00:10:12,300 there's tons of information in there. 229 00:10:12,300 --> 00:10:14,190 So then if you can figure out 230 00:10:14,190 --> 00:10:16,593 what's already included in the safety bundles, 231 00:10:18,000 --> 00:10:19,110 and is your organization 232 00:10:19,110 --> 00:10:21,270 already meeting these recommendations, 233 00:10:21,270 --> 00:10:23,010 or do you guys have a lot of work to do 234 00:10:23,010 --> 00:10:25,140 to meet the recommendations? 235 00:10:25,140 --> 00:10:27,090 So first, before you start running drills, 236 00:10:27,090 --> 00:10:29,040 I'd say look at your workflows, 237 00:10:29,040 --> 00:10:32,130 and are you in alignment with the current recommendations, 238 00:10:32,130 --> 00:10:34,530 or do you need to start, you know, a couple steps back, 239 00:10:34,530 --> 00:10:37,050 and adapt some of your workflows 240 00:10:37,050 --> 00:10:40,050 to make sure that you're meeting all of the recommendations? 241 00:10:41,070 --> 00:10:42,030 The other thing is too, 242 00:10:42,030 --> 00:10:43,890 what's critical to understand in doing, 243 00:10:43,890 --> 00:10:45,423 if you're gonna run a drill, 244 00:10:46,380 --> 00:10:48,600 it's hard to be the person both running the drill 245 00:10:48,600 --> 00:10:51,600 and then debriefing and facilitating the drill. 246 00:10:51,600 --> 00:10:53,580 So when we're at these conferences, 247 00:10:53,580 --> 00:10:54,413 a lot of times what happens 248 00:10:54,413 --> 00:10:55,770 is there's someone actually running the drill, 249 00:10:55,770 --> 00:10:56,610 and being the patient, 250 00:10:56,610 --> 00:10:57,540 and saying what's going on, 251 00:10:57,540 --> 00:11:00,210 and then there's someone kind of watching to debrief later, 252 00:11:00,210 --> 00:11:01,530 to talk about how it went, 253 00:11:01,530 --> 00:11:02,430 and what we could do better, 254 00:11:02,430 --> 00:11:03,390 or was there any confusion. 255 00:11:03,390 --> 00:11:05,640 It's hard to be those two people at once. 256 00:11:05,640 --> 00:11:06,883 So a lot of times this has to be 257 00:11:06,883 --> 00:11:11,883 a kind of combined tag team with someone else in mind, 258 00:11:12,300 --> 00:11:15,810 and it can change varying on the day that goes on. 259 00:11:15,810 --> 00:11:18,960 But it's a big task to take both on it once, 260 00:11:18,960 --> 00:11:21,333 unless you really feel comfortable in that, 261 00:11:23,400 --> 00:11:24,270 whatever you're running, 262 00:11:24,270 --> 00:11:25,103 that you feel comfortable 263 00:11:25,103 --> 00:11:26,600 kind of debriefing and facilitating, 264 00:11:26,600 --> 00:11:28,470 at the same time and you feel comfortable with your staff. 265 00:11:28,470 --> 00:11:31,353 Just know that having a buddy can help in this situation. 266 00:11:35,100 --> 00:11:37,380 So a little bit more just in terms of getting, 267 00:11:37,380 --> 00:11:41,463 if you are the facilitator or a co-facilitator, 268 00:11:42,570 --> 00:11:45,750 you know, before you want to run through scenarios 269 00:11:45,750 --> 00:11:48,060 with folks and have them respond appropriately, 270 00:11:48,060 --> 00:11:51,480 you wanna make sure that you really understand the processes 271 00:11:51,480 --> 00:11:53,490 at your own organization. 272 00:11:53,490 --> 00:11:57,210 So, you know, before you run a postpartum hemorrhage drill, 273 00:11:57,210 --> 00:12:00,030 do you have a mass transfusion policy at your hospital? 274 00:12:00,030 --> 00:12:02,700 If you do, and you don't run them frequently, 275 00:12:02,700 --> 00:12:04,500 really helpful to incorporate 276 00:12:04,500 --> 00:12:06,600 talking through this process in the drill. 277 00:12:06,600 --> 00:12:08,250 But to feel comfortable doing that, 278 00:12:08,250 --> 00:12:10,770 you need to really understand the process yourself. 279 00:12:10,770 --> 00:12:11,850 I know for myself, 280 00:12:11,850 --> 00:12:13,590 you know, the further I get away from the bedside, 281 00:12:13,590 --> 00:12:16,263 the less comfortable I feel with these, 282 00:12:17,220 --> 00:12:20,700 with emergency workflows at the bedside. 283 00:12:20,700 --> 00:12:21,930 I can like certainly speak to them, 284 00:12:21,930 --> 00:12:24,600 but if you want me to be the one to open up Epic 285 00:12:24,600 --> 00:12:26,040 and order the MTP, 286 00:12:26,040 --> 00:12:27,630 like I'll be a little rusty, 287 00:12:27,630 --> 00:12:29,790 'cause I haven't been at the bedside. 288 00:12:29,790 --> 00:12:31,200 So I think, you know, 289 00:12:31,200 --> 00:12:32,880 making sure that you feel really comfortable 290 00:12:32,880 --> 00:12:33,720 speaking to this, 291 00:12:33,720 --> 00:12:35,220 and being able to answer questions 292 00:12:35,220 --> 00:12:38,370 about protocols at your hospital, 293 00:12:38,370 --> 00:12:39,870 will help you feel much more comfortable 294 00:12:39,870 --> 00:12:41,403 jumping into running a drill. 295 00:12:42,960 --> 00:12:43,793 Similarly, 296 00:12:43,793 --> 00:12:45,870 like do you already have a postpartum hemorrhage cart? 297 00:12:45,870 --> 00:12:47,553 Do you know what's in it? 298 00:12:49,500 --> 00:12:51,510 Do you know when it's expected to be used? 299 00:12:51,510 --> 00:12:54,510 Do you know what the process is for weighing. 300 00:12:54,510 --> 00:12:57,120 You know, do you feel comfortable with all of those things? 301 00:12:57,120 --> 00:12:57,953 If you don't, 302 00:12:57,953 --> 00:13:01,260 you should reacclimate yourself with that stuff 303 00:13:01,260 --> 00:13:02,970 before you try to do it in a drill. 304 00:13:02,970 --> 00:13:07,380 Similarly, do you have a virtual postpartum hemorrhage kit 305 00:13:07,380 --> 00:13:08,760 in your Pixis? 306 00:13:08,760 --> 00:13:10,080 Do you know how to access it? 307 00:13:10,080 --> 00:13:12,690 You know, you wanna make sure that you can speak to that, 308 00:13:12,690 --> 00:13:14,100 so that if people have questions, 309 00:13:14,100 --> 00:13:16,350 you're comfortable to answer them on the fly. 310 00:13:20,610 --> 00:13:24,900 Again, debriefing and reporting. 311 00:13:24,900 --> 00:13:29,221 The debriefing is gonna be a huge part of running drills. 312 00:13:29,221 --> 00:13:33,630 I would say the most important part, really, is the debrief, 313 00:13:33,630 --> 00:13:35,940 it's where like, the most learning can take place, 314 00:13:35,940 --> 00:13:37,800 and where the most damage can be done 315 00:13:37,800 --> 00:13:42,120 if you don't address it correctly. 316 00:13:42,120 --> 00:13:45,270 So, again, do you guys have debriefing forms 317 00:13:45,270 --> 00:13:46,560 on your unit already? 318 00:13:46,560 --> 00:13:48,813 Is this a practice that you're used to doing? 319 00:13:50,010 --> 00:13:51,030 If it's not, 320 00:13:51,030 --> 00:13:53,910 if debriefing isn't super routine, 321 00:13:53,910 --> 00:13:56,700 and you don't already have an established process, 322 00:13:56,700 --> 00:13:58,473 I would say, establish one. 323 00:14:00,360 --> 00:14:02,880 We have kind of two different reporting systems, 324 00:14:02,880 --> 00:14:05,790 and it depends on the severity of the event. 325 00:14:05,790 --> 00:14:10,020 But we really encourage folks to be debriefing events 326 00:14:10,020 --> 00:14:12,750 in real time, as close to the incident as possible, 327 00:14:12,750 --> 00:14:16,203 with as many members of the care team as possible. 328 00:14:17,280 --> 00:14:20,310 You know, for things that have poor outcomes, 329 00:14:20,310 --> 00:14:23,670 and for things that go well. 330 00:14:23,670 --> 00:14:25,410 There's no reason you can't debrief something 331 00:14:25,410 --> 00:14:26,760 that had a great outcome, 332 00:14:26,760 --> 00:14:28,380 especially if you wanna call attention 333 00:14:28,380 --> 00:14:30,300 to the things that worked really well, 334 00:14:30,300 --> 00:14:31,350 and that you thought, you know, 335 00:14:31,350 --> 00:14:33,933 excellent teamwork around specific things. 336 00:14:34,830 --> 00:14:36,210 Definitely call that out. 337 00:14:36,210 --> 00:14:39,000 Debriefs don't have to just be for bad outcomes 338 00:14:39,000 --> 00:14:40,833 or stressful situations. 339 00:14:41,820 --> 00:14:44,610 But, again, before running the drill, 340 00:14:44,610 --> 00:14:46,590 make sure you understand what your own process is, 341 00:14:46,590 --> 00:14:49,440 and what the expectations are at your hospital now, 342 00:14:49,440 --> 00:14:52,623 and develop a process if there isn't one already in place. 343 00:14:57,120 --> 00:15:00,390 And then, again, in preparation, 344 00:15:00,390 --> 00:15:02,310 the binders come with scenarios. 345 00:15:02,310 --> 00:15:06,150 So, each binder is its own topic. 346 00:15:06,150 --> 00:15:07,830 So there's the hypertension binder, 347 00:15:07,830 --> 00:15:10,500 and the hemorrhage binder. 348 00:15:10,500 --> 00:15:13,530 Each binder has three different scenarios, 349 00:15:13,530 --> 00:15:17,940 so definitely pull the scenarios out and read through them. 350 00:15:17,940 --> 00:15:21,960 I think understanding the objectives for participants, 351 00:15:21,960 --> 00:15:23,640 you know, and what each participant needs 352 00:15:23,640 --> 00:15:28,140 to do or accomplish before this scenario can be complete 353 00:15:28,140 --> 00:15:31,260 is really important. 354 00:15:31,260 --> 00:15:32,160 So, you know, 355 00:15:32,160 --> 00:15:35,100 you don't need to memorize every step of the scenario, 356 00:15:35,100 --> 00:15:36,030 definitely not, 357 00:15:36,030 --> 00:15:39,390 you know, there's checklists, and there's role cards, 358 00:15:39,390 --> 00:15:41,280 and you have the scenario printed out. 359 00:15:41,280 --> 00:15:43,800 They all have like this flow diagram, 360 00:15:43,800 --> 00:15:47,520 so it starts with like, your vital signs at the top, 361 00:15:47,520 --> 00:15:48,930 and like what's going on with the patient, 362 00:15:48,930 --> 00:15:50,910 and it's really like step by step. 363 00:15:50,910 --> 00:15:52,620 So you don't need to memorize it, 364 00:15:52,620 --> 00:15:54,970 but you definitely wanna feel familiar with it. 365 00:15:57,431 --> 00:16:00,180 And then aside from the scenario itself, 366 00:16:00,180 --> 00:16:02,010 like what else are you gonna need 367 00:16:02,010 --> 00:16:05,190 to make this feel more realistic? 368 00:16:05,190 --> 00:16:07,680 And it's totally up to the facilitators, 369 00:16:07,680 --> 00:16:09,730 how realistic do you wanna get with this? 370 00:16:12,300 --> 00:16:15,720 You know, at 5:00 AM it's gonna be a struggle 371 00:16:15,720 --> 00:16:18,840 to get everybody up and participating, 372 00:16:18,840 --> 00:16:21,270 at 5:00 AM, you know, maybe is not the time 373 00:16:21,270 --> 00:16:24,540 to run this super high fidelity, complicated scenario. 374 00:16:24,540 --> 00:16:26,370 Maybe at 5:00 AM is more the time 375 00:16:26,370 --> 00:16:28,110 to just kind of pull people together 376 00:16:28,110 --> 00:16:30,750 and talk through a scenario. 377 00:16:30,750 --> 00:16:35,750 So you can decide how realistic you want it to be, 378 00:16:37,680 --> 00:16:39,660 high fidelity is, it's great, 379 00:16:39,660 --> 00:16:42,150 but it's a lot on the facilitators. 380 00:16:42,150 --> 00:16:43,200 So don't, I would say, 381 00:16:43,200 --> 00:16:44,730 you know, especially when you're starting out, 382 00:16:44,730 --> 00:16:46,530 like don't put a lot of pressure on yourself 383 00:16:46,530 --> 00:16:48,000 to feel like this is perfect. 384 00:16:48,000 --> 00:16:50,010 You know, "I have all of the props, 385 00:16:50,010 --> 00:16:50,880 I have all the stuff, 386 00:16:50,880 --> 00:16:52,830 I have my fake blood, and the fake IV." 387 00:16:54,000 --> 00:16:55,800 It's not necessary 388 00:16:55,800 --> 00:16:58,710 for it to be a meaningful learning experience, 389 00:16:58,710 --> 00:17:01,080 but it does, I think, make it more fun. 390 00:17:01,080 --> 00:17:01,913 So, you know, 391 00:17:01,913 --> 00:17:04,200 if you know when you're gonna do on next Friday 392 00:17:04,200 --> 00:17:05,190 in the middle of the day, 393 00:17:05,190 --> 00:17:08,283 and you wanna get it like super fancy, go for it. 394 00:17:09,145 --> 00:17:12,090 But don't feel like you have to do those things 395 00:17:12,090 --> 00:17:14,220 in order for it to be meaningful. 396 00:17:14,220 --> 00:17:15,053 But, you know -- 397 00:17:15,053 --> 00:17:15,886 Yeah. 398 00:17:15,886 --> 00:17:16,719 Sorry, Amelie. 399 00:17:16,719 --> 00:17:17,552 Go ahead. 400 00:17:17,552 --> 00:17:18,385 I think it's important to know 401 00:17:18,385 --> 00:17:20,790 that if it feels like a hurdle 402 00:17:20,790 --> 00:17:22,530 with all the stuff to run the drill, 403 00:17:22,530 --> 00:17:25,203 then don't worry about the stuff. 404 00:17:27,159 --> 00:17:29,910 And I know at night it's really difficult to plan sometimes 405 00:17:29,910 --> 00:17:32,040 to do a simulation, because the census to the board, 406 00:17:32,040 --> 00:17:33,900 and the staff, and what's going on. 407 00:17:33,900 --> 00:17:36,000 And if you just can't get the stuff together, 408 00:17:36,000 --> 00:17:38,280 but you wanna run a quick drill over something, 409 00:17:38,280 --> 00:17:40,290 then do it, and make it fun, 410 00:17:40,290 --> 00:17:42,120 maybe hand out little index cards 411 00:17:42,120 --> 00:17:43,177 that says you're the resident, you're the nurse, 412 00:17:43,177 --> 00:17:45,240 you know, and make it fun that way. 413 00:17:45,240 --> 00:17:47,190 But make it as easy as possible, 414 00:17:47,190 --> 00:17:48,450 and make it fun for everyone. 415 00:17:48,450 --> 00:17:50,280 And not everyone's supposed to know everything, 416 00:17:50,280 --> 00:17:53,400 it's supposed to be a group learning experience 417 00:17:53,400 --> 00:17:56,043 that everyone's there to enjoy, I guess, in a way. 418 00:17:56,910 --> 00:17:58,260 [Marge] I just put in the chat, 419 00:17:58,260 --> 00:18:00,600 it's not a test, feel free to cheat. 420 00:18:00,600 --> 00:18:03,270 We gave you a ton of stuff to cheat from, 421 00:18:03,270 --> 00:18:05,370 feel free to let everybody cheat, 422 00:18:05,370 --> 00:18:07,470 make sure that the nurses have available 423 00:18:07,470 --> 00:18:09,180 everything that they need to cheat. 424 00:18:09,180 --> 00:18:12,750 The idea is for people to know and develop muscle memory. 425 00:18:12,750 --> 00:18:15,420 And I can't emphasize what Wendy said enough, 426 00:18:15,420 --> 00:18:16,563 you make this, 427 00:18:17,564 --> 00:18:20,550 we develop these to make them as low barrier 428 00:18:20,550 --> 00:18:22,200 as you wanna do 'em, 429 00:18:22,200 --> 00:18:26,610 and I would 100% recommend you start 430 00:18:26,610 --> 00:18:29,700 with the lowest level of barriers, 431 00:18:29,700 --> 00:18:32,490 to just talk through the scenarios as you can. 432 00:18:32,490 --> 00:18:35,553 The important thing is to do them, rather than not do them. 433 00:18:37,830 --> 00:18:38,823 Absolutely. 434 00:18:39,660 --> 00:18:42,570 So for ours, like here at our hospital, 435 00:18:42,570 --> 00:18:44,310 we have the binders out, 436 00:18:44,310 --> 00:18:45,540 and then with each binder, 437 00:18:45,540 --> 00:18:47,610 there's like a little kit of supplies. 438 00:18:47,610 --> 00:18:49,680 For the hypertension, 439 00:18:49,680 --> 00:18:51,630 it's very minimal stuff that's required, 440 00:18:51,630 --> 00:18:54,420 so I just have like a little envelope, 441 00:18:54,420 --> 00:18:56,610 plastic envelope that goes right in the binder, 442 00:18:56,610 --> 00:18:58,020 a three ring, you know, envelope, 443 00:18:58,020 --> 00:18:59,490 and it has like these, 444 00:18:59,490 --> 00:19:02,580 I have printed out fake files of meds, 445 00:19:02,580 --> 00:19:04,320 and just printed them in color, 446 00:19:04,320 --> 00:19:05,280 and then laminated them. 447 00:19:05,280 --> 00:19:09,150 So you know, if somebody's going to grab hydralazine, 448 00:19:09,150 --> 00:19:13,080 they're just getting a little laminated picture 449 00:19:13,080 --> 00:19:14,640 of hydralazine. 450 00:19:14,640 --> 00:19:17,250 You know, people don't need to be pulling real meds, 451 00:19:17,250 --> 00:19:19,290 we don't need to be drawing medications up 452 00:19:19,290 --> 00:19:21,600 unless you feel like that would actually be helpful. 453 00:19:21,600 --> 00:19:24,210 I mean maybe you don't have hypertensive crises 454 00:19:24,210 --> 00:19:25,290 frequently on your unit, 455 00:19:25,290 --> 00:19:28,200 and maybe it would be helpful to review the dosing, 456 00:19:28,200 --> 00:19:30,360 to review the volume. 457 00:19:30,360 --> 00:19:32,460 If you feel like that's helpful for you, 458 00:19:32,460 --> 00:19:34,110 then totally do that. 459 00:19:34,110 --> 00:19:37,230 Some other places, like we do it a lot with real patients, 460 00:19:37,230 --> 00:19:39,720 so for us it doesn't feel like we need to practice 461 00:19:39,720 --> 00:19:41,583 with actually drawing up medications. 462 00:19:43,740 --> 00:19:46,203 And again, like if you're planning ahead of time, 463 00:19:47,790 --> 00:19:48,690 if you're gonna have, 464 00:19:48,690 --> 00:19:52,170 some places have like these high fidelity mannequins 465 00:19:52,170 --> 00:19:54,390 that can have postpartum hemorrhages, 466 00:19:54,390 --> 00:19:56,160 and that is great if you have it, 467 00:19:56,160 --> 00:19:57,090 and you know how to use it, 468 00:19:57,090 --> 00:19:58,560 and you want to, 469 00:19:58,560 --> 00:20:01,500 but you can also like pull a nurse off the postpartum unit. 470 00:20:01,500 --> 00:20:05,280 Or you know, I think it's helpful to not use someone 471 00:20:05,280 --> 00:20:06,600 that they see all the time, 472 00:20:06,600 --> 00:20:09,780 'cause that like immediately makes it not very realistic. 473 00:20:09,780 --> 00:20:12,540 But it's nice to have a real person, 474 00:20:12,540 --> 00:20:14,070 'cause they can interact, 475 00:20:14,070 --> 00:20:15,360 you know, they can answer questions, 476 00:20:15,360 --> 00:20:17,430 it makes it feel a little bit more realistic. 477 00:20:17,430 --> 00:20:21,450 But again, if you have everything you need to run a drill, 478 00:20:21,450 --> 00:20:23,520 but you don't have a person to be the patient, 479 00:20:23,520 --> 00:20:25,710 then just go for it anyway, 480 00:20:25,710 --> 00:20:28,510 and just talk through what's happening with the patient. 481 00:20:30,870 --> 00:20:33,930 We also have like, just pictures of blood products, 482 00:20:33,930 --> 00:20:36,270 again, that I just laminated. 483 00:20:36,270 --> 00:20:39,300 So you know, if people are calling for blood products, 484 00:20:39,300 --> 00:20:43,950 you can go step by step through the whole ordering process 485 00:20:43,950 --> 00:20:45,990 if that's what you wanna focus on. 486 00:20:45,990 --> 00:20:48,870 Sometimes, like, that's what really needs to be practiced 487 00:20:48,870 --> 00:20:49,703 and talked through, 488 00:20:49,703 --> 00:20:50,536 like what's the best way 489 00:20:50,536 --> 00:20:52,680 to get blood products up here quickly. 490 00:20:52,680 --> 00:20:55,680 That could be the focus of your postpartum hemorrhage drill. 491 00:20:56,521 --> 00:20:57,990 It really needs to be catered 492 00:20:57,990 --> 00:21:00,270 to what you feel like is the most helpful thing 493 00:21:00,270 --> 00:21:01,353 for you to review. 494 00:21:02,910 --> 00:21:05,160 For my nursing education days this year, 495 00:21:05,160 --> 00:21:08,040 we're gonna do a postpartum hemorrhage scenario, 496 00:21:08,040 --> 00:21:10,440 and we just implemented 497 00:21:10,440 --> 00:21:13,140 A1's postpartum hemorrhage risk assessment tool 498 00:21:13,140 --> 00:21:15,900 and embedded it into our electronic medical record, 499 00:21:15,900 --> 00:21:17,310 so a big part of our simulation 500 00:21:17,310 --> 00:21:18,840 is gonna be talking about the tool, 501 00:21:18,840 --> 00:21:20,580 and how to do correct documentation 502 00:21:20,580 --> 00:21:22,140 so that the tool works correctly 503 00:21:22,140 --> 00:21:25,290 and we have accurate risk assessments on our patients. 504 00:21:25,290 --> 00:21:27,986 So it's like, you know, focus on what you need to focus on 505 00:21:27,986 --> 00:21:30,540 and where you see the gaps for folks, 506 00:21:30,540 --> 00:21:34,140 and that could just be with the basics of response, 507 00:21:34,140 --> 00:21:36,630 or it could be to these more like little nuanced things 508 00:21:36,630 --> 00:21:37,923 that are specific to you. 509 00:21:44,670 --> 00:21:46,950 And so kind of like I was saying before in preparation, 510 00:21:46,950 --> 00:21:48,480 develop your resources. 511 00:21:48,480 --> 00:21:50,910 Do you already have an algorithm 512 00:21:50,910 --> 00:21:55,080 for hypertensive crisis IV medication administration? 513 00:21:55,080 --> 00:21:56,850 If you already have an algorithm, 514 00:21:56,850 --> 00:21:59,280 use that algorithm in your drills. 515 00:21:59,280 --> 00:22:01,770 Like Marge was saying, this is not a test. 516 00:22:01,770 --> 00:22:05,220 You want people to know what their resources are, 517 00:22:05,220 --> 00:22:06,840 you want them to know where they are, 518 00:22:06,840 --> 00:22:09,480 when to use them, how to use them. 519 00:22:09,480 --> 00:22:11,850 So I encourage people, 520 00:22:11,850 --> 00:22:14,550 you know, pull that algorithm right down off the wall, 521 00:22:14,550 --> 00:22:16,590 and put it at the bedside, and use it. 522 00:22:16,590 --> 00:22:19,020 You know, you don't need to memorize the dosing, 523 00:22:19,020 --> 00:22:21,390 you need to know where the algorithm is 524 00:22:21,390 --> 00:22:22,833 and you need to refer to it. 525 00:22:24,630 --> 00:22:26,250 So if you don't have an algorithm, 526 00:22:26,250 --> 00:22:29,523 you know, AIM has examples, 527 00:22:30,360 --> 00:22:32,250 we shared an example, 528 00:22:32,250 --> 00:22:35,583 you can either just use theirs, or you can develop your own. 529 00:22:37,110 --> 00:22:38,910 if you don't have a postpartum hemorrhage cart, 530 00:22:38,910 --> 00:22:41,660 again, we gave you an example of ours and what's in it, 531 00:22:42,750 --> 00:22:44,010 you know, create one, 532 00:22:44,010 --> 00:22:46,830 and the drill can really be around 533 00:22:46,830 --> 00:22:48,870 the postpartum hemorrhage cart and how to use it, 534 00:22:48,870 --> 00:22:50,733 if that's new for your area. 535 00:22:54,810 --> 00:22:57,480 All right, so once you, as the facilitator, you know, 536 00:22:57,480 --> 00:23:00,840 once you've decided who is facilitating these drills, 537 00:23:00,840 --> 00:23:03,390 who's responsible for making sure that they're happening, 538 00:23:03,390 --> 00:23:07,500 for us, you know, we really wanted, 539 00:23:07,500 --> 00:23:08,790 I think our biggest focus 540 00:23:08,790 --> 00:23:12,330 was empowering the folks who are working on the floor 541 00:23:12,330 --> 00:23:14,730 to run drills when it's most appropriate 542 00:23:14,730 --> 00:23:16,770 to run a drill on the floor. 543 00:23:16,770 --> 00:23:21,540 It's great if you have leaders, educator, manager, 544 00:23:21,540 --> 00:23:23,310 you know, clinical nurse specialists, 545 00:23:23,310 --> 00:23:26,400 who want to schedule these things in advance, 546 00:23:26,400 --> 00:23:27,540 and facilitate them. 547 00:23:27,540 --> 00:23:32,540 And you know, we do do four hours, eight hours a year 548 00:23:32,940 --> 00:23:36,120 of interdisciplinary drills in the UVM Sim Lab, 549 00:23:36,120 --> 00:23:38,310 you know, that's very different. 550 00:23:38,310 --> 00:23:41,257 But we wanted people to feel comfortable saying, 551 00:23:41,257 --> 00:23:42,840 "You know what, it's low census, 552 00:23:42,840 --> 00:23:45,330 I'm about to downstaff a nurse or two, 553 00:23:45,330 --> 00:23:48,120 and like, I wanna run a drill right now." 554 00:23:48,120 --> 00:23:53,120 So our model is that our attending, 555 00:23:54,750 --> 00:23:55,890 we call 'em the 7OE, 556 00:23:55,890 --> 00:23:59,250 it's like the hospitalist who's covering for the day, 557 00:23:59,250 --> 00:24:00,600 they are kind of responsible 558 00:24:00,600 --> 00:24:02,820 for identifying moments on the unit 559 00:24:02,820 --> 00:24:05,190 that seem appropriate to run a drill. 560 00:24:05,190 --> 00:24:07,390 And then collaborating with the charge nurse 561 00:24:08,700 --> 00:24:10,260 to run it together. 562 00:24:10,260 --> 00:24:11,887 Certainly a charge nurse could say, 563 00:24:11,887 --> 00:24:13,860 "Oh, you know, hey Dr. Conway, 564 00:24:13,860 --> 00:24:16,380 I'm about to downstaff two nurses. 565 00:24:16,380 --> 00:24:18,090 Are you in a good place to run a drill first 566 00:24:18,090 --> 00:24:19,800 before I do that?" 567 00:24:19,800 --> 00:24:20,700 But also, you know, 568 00:24:20,700 --> 00:24:22,867 totally appropriate for the provider to come out and say, 569 00:24:22,867 --> 00:24:25,390 "You know, is there anything going on that I'm not aware of? 570 00:24:25,390 --> 00:24:26,847 Let's run a drill." 571 00:24:29,430 --> 00:24:30,780 As Wendy was saying, you know, 572 00:24:30,780 --> 00:24:33,060 really, really, I think, very critical 573 00:24:33,060 --> 00:24:36,120 to have two people who are participating. 574 00:24:36,120 --> 00:24:38,460 You have one person who's, 575 00:24:38,460 --> 00:24:41,223 you know, making sure you have all the equipment, 576 00:24:43,260 --> 00:24:44,850 making sure, logistically, 577 00:24:44,850 --> 00:24:46,920 that you have stuff that you need, 578 00:24:46,920 --> 00:24:50,737 and they'll probably be kind of like, 579 00:24:52,477 --> 00:24:54,150 you know, the mole in the room. 580 00:24:54,150 --> 00:24:56,460 If they need information, you're providing it. 581 00:24:56,460 --> 00:24:59,490 If they don't understand something or need to be redirected, 582 00:24:59,490 --> 00:25:01,020 you're the one who's doing it. 583 00:25:01,020 --> 00:25:02,820 Then you have another facilitator 584 00:25:02,820 --> 00:25:06,120 who is more observing, taking notes, 585 00:25:06,120 --> 00:25:08,790 and is gonna be really prepared to provide feedback 586 00:25:08,790 --> 00:25:12,813 at the end of the scenario. 587 00:25:14,100 --> 00:25:15,480 Again, it's open book, 588 00:25:15,480 --> 00:25:16,470 this isn't a test. 589 00:25:16,470 --> 00:25:19,620 So there's checklists, grab the checklist. 590 00:25:19,620 --> 00:25:23,040 You know, you don't have to memorize all the steps 591 00:25:23,040 --> 00:25:27,300 for what an anesthesiologist, or an OB resident, or a nurse, 592 00:25:27,300 --> 00:25:28,133 needs to do, 593 00:25:28,133 --> 00:25:32,254 what you need to know is where your resources are. 594 00:25:32,254 --> 00:25:33,570 And one more thing on the debrief. 595 00:25:33,570 --> 00:25:35,257 So one of the things we're trained at, 596 00:25:35,257 --> 00:25:37,050 you know, this group of debriefers 597 00:25:37,050 --> 00:25:38,340 comes from across the country to sit, 598 00:25:38,340 --> 00:25:42,660 and we take, basically we get a long discussion 599 00:25:42,660 --> 00:25:44,010 on how to debrief in language. 600 00:25:44,010 --> 00:25:47,310 And what's really important and take home in that, 601 00:25:47,310 --> 00:25:48,540 what I've been trained 602 00:25:48,540 --> 00:25:50,130 through the Society for Maternal Fetal Medicine 603 00:25:50,130 --> 00:25:52,380 is that the debrief is not to be threatening, 604 00:25:52,380 --> 00:25:53,850 it's not to make anyone feel bad, 605 00:25:53,850 --> 00:25:56,970 and it's mainly meant to make everyone talk, 606 00:25:56,970 --> 00:25:59,520 and feel heard and understood. 607 00:25:59,520 --> 00:26:01,920 And if something's missed, it's not a big deal, 608 00:26:01,920 --> 00:26:03,000 not a big deal. 609 00:26:03,000 --> 00:26:04,777 And language of, you know, 610 00:26:04,777 --> 00:26:06,450 "Well, what could you have done better?" 611 00:26:06,450 --> 00:26:08,820 Not good for debriefing. (laughs) 612 00:26:08,820 --> 00:26:10,087 You know, say things like, 613 00:26:10,087 --> 00:26:14,580 "hey, that seemed like it was fun for you guys," 614 00:26:14,580 --> 00:26:15,900 or "how did you feel about that?" 615 00:26:15,900 --> 00:26:18,180 or "is there anything in particular you wanna talk about?" 616 00:26:18,180 --> 00:26:20,760 You know, something very open-ended and non-threatening 617 00:26:20,760 --> 00:26:21,780 to get everyone talking, 618 00:26:21,780 --> 00:26:23,220 and the goal of the debriefer 619 00:26:23,220 --> 00:26:25,230 is to get everyone to discuss 620 00:26:25,230 --> 00:26:26,670 what they felt was happening, 621 00:26:26,670 --> 00:26:28,860 and any small point they were confused about, 622 00:26:28,860 --> 00:26:31,200 not to necessarily drill in a point 623 00:26:31,200 --> 00:26:35,100 that they missed a dosing, or a step. 624 00:26:35,100 --> 00:26:36,420 And if they did, talk about it. 625 00:26:36,420 --> 00:26:38,310 You know, what happens here? 626 00:26:38,310 --> 00:26:39,330 What do we know about this? 627 00:26:39,330 --> 00:26:40,770 Have guidelines changed? 628 00:26:40,770 --> 00:26:41,892 I don't know. 629 00:26:41,892 --> 00:26:43,170 I feel like guidelines change every five minutes, 630 00:26:43,170 --> 00:26:45,360 and sometimes I have to look stuff up again, 631 00:26:45,360 --> 00:26:47,010 and relearn it differently. 632 00:26:47,010 --> 00:26:48,630 So I think that that's important to say, 633 00:26:48,630 --> 00:26:51,967 no matter your experience base, it's important to say, 634 00:26:51,967 --> 00:26:53,730 "Gosh, that's changed and I didn't know that," 635 00:26:53,730 --> 00:26:55,410 or "I hear you, 636 00:26:55,410 --> 00:26:57,420 and let's talk about why you thought that way," 637 00:26:57,420 --> 00:27:01,080 but never to make anyone feel like they did something wrong 638 00:27:01,080 --> 00:27:01,913 per se. 639 00:27:02,880 --> 00:27:03,713 Totally. 640 00:27:05,370 --> 00:27:08,100 So for the pre-brief, I've definitely found 641 00:27:08,100 --> 00:27:11,100 that it's very, very helpful to prepare people for this. 642 00:27:11,100 --> 00:27:14,190 Like, nobody loves to be caught off guard, 643 00:27:14,190 --> 00:27:17,820 nobody wants to be like in the spotlight feeling unprepared. 644 00:27:17,820 --> 00:27:19,957 So I think, you know, tell people, 645 00:27:19,957 --> 00:27:21,060 "We're gonna run a drill, 646 00:27:21,060 --> 00:27:23,790 it's gonna be on on postpartum hemorrhage. 647 00:27:23,790 --> 00:27:25,515 These are role cards. 648 00:27:25,515 --> 00:27:28,830 These are your responsibilities in this drill. 649 00:27:28,830 --> 00:27:30,313 This is what's expected of you." 650 00:27:30,313 --> 00:27:33,840 I think people feel much more comfortable 651 00:27:33,840 --> 00:27:35,700 when it's all laid out ahead of time. 652 00:27:35,700 --> 00:27:38,730 And I've also like, if you don't explain things too much, 653 00:27:38,730 --> 00:27:39,990 it just leads to confusion. 654 00:27:39,990 --> 00:27:42,570 Like there's definitely been times where they're like, 655 00:27:42,570 --> 00:27:47,400 not clear like what the facilitators are there for, 656 00:27:47,400 --> 00:27:49,410 if they can ask facilitators, 657 00:27:49,410 --> 00:27:51,990 you know, like, is this facilitator participating? 658 00:27:51,990 --> 00:27:54,030 Or you know, just be really, really clear 659 00:27:54,030 --> 00:27:56,220 so everyone knows what everyone's doing, 660 00:27:56,220 --> 00:27:58,120 what everybody's responsibilities are. 661 00:27:59,760 --> 00:28:01,860 Like name tags are helpful, 662 00:28:01,860 --> 00:28:03,900 you know, not your name, but your role, 663 00:28:03,900 --> 00:28:07,350 so you know, nurse, resident, 664 00:28:07,350 --> 00:28:08,760 depends on who's part of your team. 665 00:28:08,760 --> 00:28:09,960 But it has helped, 666 00:28:09,960 --> 00:28:13,140 and definitely a facilitator role, 667 00:28:13,140 --> 00:28:16,140 because people are gonna be like walking in to the scenario, 668 00:28:16,140 --> 00:28:17,220 you know, they hit the call light, 669 00:28:17,220 --> 00:28:19,350 someone new comes in, they might not know what's going on. 670 00:28:19,350 --> 00:28:22,140 Like they can see Amelie and Wendy are the facilitators, 671 00:28:22,140 --> 00:28:25,050 so like they're not asking us to, you know, 672 00:28:25,050 --> 00:28:26,433 go page anesthesia. 673 00:28:30,510 --> 00:28:33,840 And again, sharing the details of the patient's case 674 00:28:33,840 --> 00:28:37,230 with the primary nurse prior to her entering the room. 675 00:28:37,230 --> 00:28:39,360 So, you know, helping people to 676 00:28:39,360 --> 00:28:42,030 just feel like they know what they're walking into. 677 00:28:42,030 --> 00:28:43,560 You know, the technique of like, 678 00:28:43,560 --> 00:28:45,910 we'll just hit a call light and have them come, 679 00:28:48,030 --> 00:28:49,500 it just leads to a lot of confusion, 680 00:28:49,500 --> 00:28:52,140 and people feel insecure and like unsure 681 00:28:52,140 --> 00:28:54,090 about what they're supposed to do. 682 00:28:54,090 --> 00:28:55,287 And then there's like, okay, 683 00:28:55,287 --> 00:28:57,540 and I know that's not really a patient, 684 00:28:57,540 --> 00:29:00,840 because that's a nurse from across the hall. 685 00:29:00,840 --> 00:29:01,673 So then there's like, 686 00:29:01,673 --> 00:29:04,260 like that they're a little like laughing, 687 00:29:04,260 --> 00:29:05,340 and they're not quite sure. 688 00:29:05,340 --> 00:29:08,460 So I just think like setting the expectations 689 00:29:08,460 --> 00:29:09,930 from the get-go, 690 00:29:09,930 --> 00:29:13,500 it just helps people to also participate and engage, 691 00:29:13,500 --> 00:29:14,347 and not feel like, 692 00:29:14,347 --> 00:29:17,010 "Oh, okay, this is funny, and this is weird." 693 00:29:17,010 --> 00:29:17,843 You know, they're like, 694 00:29:17,843 --> 00:29:18,780 "Okay, I know what we're doing, 695 00:29:18,780 --> 00:29:20,187 and I'm ready for it." 696 00:29:25,744 --> 00:29:28,710 The debrief form, like I said, 697 00:29:28,710 --> 00:29:31,510 if you have one that you already use, you should use it. 698 00:29:32,670 --> 00:29:35,520 So what I've been doing with folks is, 699 00:29:35,520 --> 00:29:37,380 after running a drill, 700 00:29:37,380 --> 00:29:40,920 I have that that group that participated in the drill 701 00:29:40,920 --> 00:29:44,310 debrief themselves like they would after a real event. 702 00:29:44,310 --> 00:29:45,423 So there's like, 703 00:29:46,260 --> 00:29:49,680 they debrief themselves using the debrief tool that we use 704 00:29:49,680 --> 00:29:50,970 for real events, 705 00:29:50,970 --> 00:29:54,090 and then once they're kind of finished debriefing themselves 706 00:29:54,090 --> 00:29:55,458 as the debriefer, 707 00:29:55,458 --> 00:29:59,310 then I, you know, get into a larger, 708 00:29:59,310 --> 00:30:02,010 kind of next level debrief with the whole group, 709 00:30:02,010 --> 00:30:03,625 and then incorporate the things 710 00:30:03,625 --> 00:30:05,850 that the facilitators observed, 711 00:30:05,850 --> 00:30:08,312 and the feedback that we wanna share. 712 00:30:08,312 --> 00:30:11,070 And sometimes the group has already kind of covered 713 00:30:11,070 --> 00:30:13,410 everything that you were gonna talk about. 714 00:30:13,410 --> 00:30:15,000 And sometimes, depending on the group, 715 00:30:15,000 --> 00:30:17,730 sometimes the facilitators really need to like, 716 00:30:17,730 --> 00:30:19,980 pull it outta people and get them to open up. 717 00:30:19,980 --> 00:30:22,860 You know, if it's a brand new crew, 718 00:30:22,860 --> 00:30:24,120 this is the first time they've done it, 719 00:30:24,120 --> 00:30:26,100 and they're just like feeling really unsure 720 00:30:26,100 --> 00:30:26,933 about everything, 721 00:30:26,933 --> 00:30:29,490 it might take a lot more like coaxing 722 00:30:29,490 --> 00:30:31,290 to get them to open up and talk about it. 723 00:30:31,290 --> 00:30:34,260 And if it's people who have done this already 724 00:30:34,260 --> 00:30:36,450 a bunch of bazillion times on an actual patient, 725 00:30:36,450 --> 00:30:38,250 they might just kind of, 726 00:30:38,250 --> 00:30:39,768 you know, zip right through the debrief 727 00:30:39,768 --> 00:30:42,033 and feel pretty good about it. 728 00:30:48,042 --> 00:30:51,750 And then also, you need to develop a way to track 729 00:30:51,750 --> 00:30:53,310 the drills that you do. 730 00:30:53,310 --> 00:30:55,320 Especially when the Joint Commission comes around, 731 00:30:55,320 --> 00:30:58,230 they wanna see who participated 732 00:30:58,230 --> 00:31:00,210 in these different types of events 733 00:31:00,210 --> 00:31:02,040 and what kind of education are people getting. 734 00:31:02,040 --> 00:31:05,610 So, very helpful to have a log. 735 00:31:05,610 --> 00:31:08,580 Again, there's an example in the binders 736 00:31:08,580 --> 00:31:10,830 of the ones that we use, 737 00:31:10,830 --> 00:31:12,570 just really simple and straightforward, 738 00:31:12,570 --> 00:31:14,278 like the date, the location, 739 00:31:14,278 --> 00:31:16,860 the topic of the scenario, 740 00:31:16,860 --> 00:31:20,490 and who participated, and who facilitated. 741 00:31:20,490 --> 00:31:21,843 We keep the log, 742 00:31:23,070 --> 00:31:27,780 there's paper copies of the log in the drill books, 743 00:31:27,780 --> 00:31:29,850 so you can just fill it out right there. 744 00:31:29,850 --> 00:31:33,120 And then I just ask people to put it in my mailbox 745 00:31:33,120 --> 00:31:35,070 right outside my office. 746 00:31:35,070 --> 00:31:39,660 And then there's an electronic copy of this as well 747 00:31:39,660 --> 00:31:40,920 in a shared location, 748 00:31:40,920 --> 00:31:42,660 so we have it on our team's channel 749 00:31:42,660 --> 00:31:44,670 so that like multiple people can access it 750 00:31:44,670 --> 00:31:46,023 and update it as well. 751 00:31:47,640 --> 00:31:52,530 But ultimately, I'm kind of responsible for tracking things, 752 00:31:54,090 --> 00:31:58,770 and then I report to Sam Bellinger, like kind of quarterly, 753 00:31:58,770 --> 00:32:02,373 on our drills, and give her copies of our log sheets. 754 00:32:07,110 --> 00:32:08,806 And then incentives, 755 00:32:08,806 --> 00:32:10,410 like Wendy was saying, 756 00:32:10,410 --> 00:32:12,090 like any way to make it fun, 757 00:32:12,090 --> 00:32:16,620 any way to make people excited about participating. 758 00:32:16,620 --> 00:32:19,470 You know, it has not historically been the culture 759 00:32:19,470 --> 00:32:22,710 on our unit at UVM to run a lot of drills, 760 00:32:22,710 --> 00:32:23,970 especially on the unit. 761 00:32:23,970 --> 00:32:25,590 I think we have done a better job about, 762 00:32:25,590 --> 00:32:28,320 you know, having activities in the sim lab, 763 00:32:28,320 --> 00:32:31,320 but to really run these in SISU drills 764 00:32:31,320 --> 00:32:34,170 in the environment where you're taking care of patients, 765 00:32:34,170 --> 00:32:36,360 it's not something that we are used to. 766 00:32:36,360 --> 00:32:37,193 So, you know, 767 00:32:38,430 --> 00:32:40,440 it takes a while to embed things into the culture, 768 00:32:40,440 --> 00:32:42,120 and I think, in that process, 769 00:32:42,120 --> 00:32:44,910 the more that you can incentivize and make it fun, 770 00:32:44,910 --> 00:32:49,020 or everybody who participated at the end of the year, 771 00:32:49,020 --> 00:32:51,210 you'll get put into a raffle 772 00:32:51,210 --> 00:32:52,950 that we'll draw at the end of the year, 773 00:32:52,950 --> 00:32:55,500 and someone will win a prize 774 00:32:55,500 --> 00:32:57,120 just for participating in the drill. 775 00:32:57,120 --> 00:33:00,030 So, stuff like that makes people, hopefully, 776 00:33:00,030 --> 00:33:01,860 like not run the other direction 777 00:33:01,860 --> 00:33:03,780 when they see you coming with the drill binder, 778 00:33:03,780 --> 00:33:08,370 because that is often what happens, you know? 779 00:33:08,370 --> 00:33:09,810 I think the more people participate, 780 00:33:09,810 --> 00:33:11,820 the more they do it, they start to feel more comfortable 781 00:33:11,820 --> 00:33:13,653 and like it's less intimidating. 782 00:33:15,360 --> 00:33:16,860 [Marge] And just so you know, I put it in the chat, 783 00:33:16,860 --> 00:33:18,630 we have a budget for prizes. 784 00:33:18,630 --> 00:33:22,884 And Sam and I, I don't know, 785 00:33:22,884 --> 00:33:25,140 if you guys have ideas of it, 786 00:33:25,140 --> 00:33:26,070 we're happy to, 787 00:33:26,070 --> 00:33:27,960 we wanted to do gift cards, 788 00:33:27,960 --> 00:33:29,700 but it was weird, we couldn't, 789 00:33:29,700 --> 00:33:33,000 there was tax things, I don't know, it was all weird stuff. 790 00:33:33,000 --> 00:33:35,040 So we're still working on that, 791 00:33:35,040 --> 00:33:36,330 just so that you know. 792 00:33:36,330 --> 00:33:41,330 But Sam is way more creative than me, and she's on it. 793 00:33:42,090 --> 00:33:42,923 Hey, Marge, 794 00:33:42,923 --> 00:33:44,790 do you know what I've done in the past at other facilities? 795 00:33:44,790 --> 00:33:46,800 I don't know if it's allowed, don't get mad at me, 796 00:33:46,800 --> 00:33:51,480 but I've done little $1 scratch off raffle tickets, 797 00:33:51,480 --> 00:33:52,313 or you know, lottery tickets. 798 00:33:52,313 --> 00:33:53,280 Lottery tickets? 799 00:33:53,280 --> 00:33:54,113 [Marge] Oh yeah, yeah. 800 00:33:54,113 --> 00:33:55,200 I can't remember. 801 00:33:55,200 --> 00:33:57,240 Because it's federal money, 'cause we -- 802 00:33:57,240 --> 00:33:58,308 Yeah, it's like, 803 00:33:58,308 --> 00:34:02,787 I bought my them myself just to like, make people -- 804 00:34:02,787 --> 00:34:06,030 [Marge] And I told Sam I was willing to do that too. 805 00:34:06,030 --> 00:34:09,360 Less angsty about it, in lottery tickets. 806 00:34:09,360 --> 00:34:11,280 [Marge] It's still on the table. (laughs) 807 00:34:11,280 --> 00:34:12,113 Yeah. 808 00:34:12,113 --> 00:34:12,946 You know? 809 00:34:15,279 --> 00:34:16,273 Yeah. 810 00:34:16,273 --> 00:34:18,900 So I think we can just open it up to questions. 811 00:34:18,900 --> 00:34:21,063 Like what do you guys wanna know? 812 00:34:23,070 --> 00:34:24,930 Can I add one more thing, 813 00:34:24,930 --> 00:34:27,930 so when we have an event happen, bad or good, 814 00:34:27,930 --> 00:34:28,763 just an example, 815 00:34:28,763 --> 00:34:30,930 we had a shoulder dystocia a couple months ago, 816 00:34:30,930 --> 00:34:32,940 and I know all of you probably have 817 00:34:32,940 --> 00:34:35,100 new travelers on your floor, 818 00:34:35,100 --> 00:34:37,710 constructions happen on floor, things change, 819 00:34:37,710 --> 00:34:38,543 and during the shoulder, 820 00:34:38,543 --> 00:34:41,250 I turn to the new traveler nurse at night, 821 00:34:41,250 --> 00:34:42,747 and I said "mark time," 822 00:34:43,980 --> 00:34:45,480 and she couldn't find a clock. 823 00:34:45,480 --> 00:34:47,190 The clock on the wall had been taken down, 824 00:34:47,190 --> 00:34:49,230 and she didn't know where the clock was on the computer, 825 00:34:49,230 --> 00:34:51,000 and I needed every 30 second interval called out, 826 00:34:51,000 --> 00:34:51,960 and when she wasn't doing that, 827 00:34:51,960 --> 00:34:55,050 another nurse figured out what was happening and took over. 828 00:34:55,050 --> 00:34:56,610 But that's one of the things we talked about, 829 00:34:56,610 --> 00:34:58,530 like what happened there during that. 830 00:34:58,530 --> 00:35:00,900 She's like, "I couldn't find a clock!" 831 00:35:00,900 --> 00:35:03,900 And so, that's an easy time to debrief, 832 00:35:03,900 --> 00:35:04,740 like a shoulder dystocia. 833 00:35:04,740 --> 00:35:05,573 What happens? 834 00:35:05,573 --> 00:35:06,510 What are the first maneuvers? 835 00:35:06,510 --> 00:35:07,710 Where are you gonna mark time? 836 00:35:07,710 --> 00:35:09,390 Where's pediatrics gonna go? 837 00:35:09,390 --> 00:35:13,410 And so it was super easy to do a quick drill after the fact, 838 00:35:13,410 --> 00:35:14,730 when everyone was really jazzed up 839 00:35:14,730 --> 00:35:15,840 and wanted to talk about it. 840 00:35:15,840 --> 00:35:17,070 Now, you don't have always have time, 841 00:35:17,070 --> 00:35:20,190 but that's a way to run a fast drill 842 00:35:20,190 --> 00:35:21,783 with realtime feedback. 843 00:35:27,000 --> 00:35:28,140 And then, you know, 844 00:35:28,140 --> 00:35:31,320 we already have people asking for other topics. 845 00:35:31,320 --> 00:35:34,740 You know, you can only run so many postpartum hemorrhage 846 00:35:34,740 --> 00:35:35,670 and hypertension drills 847 00:35:35,670 --> 00:35:37,890 before people wanna start seeing other stuff. 848 00:35:37,890 --> 00:35:42,890 So, we'll be developing new scenarios, I think. 849 00:35:44,490 --> 00:35:46,980 I think we're gonna focus on these two for 2023, 850 00:35:46,980 --> 00:35:48,300 because we really just need to like, 851 00:35:48,300 --> 00:35:50,850 I keep saying, embed this into our culture. 852 00:35:50,850 --> 00:35:52,724 So we're gonna focus on these two topics, 853 00:35:52,724 --> 00:35:55,590 and then we'll start to build from there, 854 00:35:55,590 --> 00:35:57,810 kind of depending on what we'd identify 855 00:35:57,810 --> 00:35:59,433 as the biggest needs for us. 856 00:36:00,530 --> 00:36:03,390 And I know some of the smaller hospitals in Vermont, 857 00:36:03,390 --> 00:36:05,381 the units sometimes can be way understaffed, 858 00:36:05,381 --> 00:36:06,360 you know, if you have one nurse. 859 00:36:06,360 --> 00:36:08,629 Or you can also run a drill that says, 860 00:36:08,629 --> 00:36:11,580 if you have one nurse on the floor, 861 00:36:11,580 --> 00:36:13,140 and say someone comes in for a labor check, 862 00:36:13,140 --> 00:36:14,850 and your patient that delivered yesterday 863 00:36:14,850 --> 00:36:18,090 has a delayed postpartum hemorrhage, what are you gonna do? 864 00:36:18,090 --> 00:36:21,240 Having been in the situation with one nurse on the floor, 865 00:36:21,240 --> 00:36:23,070 I asked for a rapid response team. 866 00:36:23,070 --> 00:36:24,540 They didn't have that at that facility, 867 00:36:24,540 --> 00:36:26,250 so then we called the ER. 868 00:36:26,250 --> 00:36:28,110 And I've never seen so many excited people 869 00:36:28,110 --> 00:36:29,670 happy to start IVs in my life. 870 00:36:29,670 --> 00:36:31,650 But that's another fun thing 871 00:36:31,650 --> 00:36:32,910 you could do with a smaller hospital, 872 00:36:32,910 --> 00:36:35,850 is maybe do a joint drill 873 00:36:35,850 --> 00:36:37,290 with your emergency room department, 874 00:36:37,290 --> 00:36:39,090 or you know, whoever you have after hours, 875 00:36:39,090 --> 00:36:41,073 when maybe your staffing is very low. 876 00:36:46,650 --> 00:36:48,150 [Kathleen] Hello, my name is Kathleen, 877 00:36:48,150 --> 00:36:51,660 and this is absolutely wonderful and very helpful 878 00:36:51,660 --> 00:36:54,240 for something I'm planning on doing 879 00:36:54,240 --> 00:36:57,150 as a public health person. 880 00:36:57,150 --> 00:36:59,310 So, this is wonderful. 881 00:36:59,310 --> 00:37:00,143 My question is, 882 00:37:00,143 --> 00:37:01,950 what would you say your biggest barriers 883 00:37:01,950 --> 00:37:03,660 to the rollout process was 884 00:37:03,660 --> 00:37:04,980 that you had in the beginning, 885 00:37:04,980 --> 00:37:06,360 or that you still find? 886 00:37:06,360 --> 00:37:07,237 I know that you mentioned that, 887 00:37:07,237 --> 00:37:09,930 and I was a bedside nurse for a long time, yes, 888 00:37:09,930 --> 00:37:11,580 very, very much resistance, 889 00:37:11,580 --> 00:37:12,810 and "Nope, I don't wanna do that. 890 00:37:12,810 --> 00:37:15,120 Nope. Nope. I might need to act busy." 891 00:37:15,120 --> 00:37:17,700 But how about outside of that? 892 00:37:17,700 --> 00:37:20,103 What barriers would you say to expect? 893 00:37:21,420 --> 00:37:23,670 Well, initially when we first rolled this out, 894 00:37:23,670 --> 00:37:25,740 we tried to schedule things, 895 00:37:25,740 --> 00:37:27,840 you know, not with the staff per se, 896 00:37:27,840 --> 00:37:29,970 but like the facilitators would try to schedule it 897 00:37:29,970 --> 00:37:32,130 ahead of time based on our availability, 898 00:37:32,130 --> 00:37:34,860 who's on call when, and who's available when. 899 00:37:34,860 --> 00:37:38,010 And that really did not work very well at all. 900 00:37:38,010 --> 00:37:40,680 I mean, it was like every single time we had a drill, 901 00:37:40,680 --> 00:37:43,920 that just guarantees that the unit is exploding 902 00:37:43,920 --> 00:37:45,690 and that we have four call outs. 903 00:37:45,690 --> 00:37:50,250 So we stopped doing that pretty quickly, 904 00:37:50,250 --> 00:37:53,647 And, you know, we still occasionally will try, I'll say, 905 00:37:53,647 --> 00:37:55,860 "Oh, next Wednesday I'll come in for an evening shift, 906 00:37:55,860 --> 00:37:58,560 and we'll try to run one on the night shift." 907 00:37:58,560 --> 00:38:02,520 But I would say it's this, 908 00:38:02,520 --> 00:38:05,040 it's like the identifying the appropriate times, 909 00:38:05,040 --> 00:38:08,850 and then somehow empowering the people who are there 910 00:38:08,850 --> 00:38:10,770 to feel comfortable to do it. 911 00:38:10,770 --> 00:38:12,990 You know, when you have a provider like Wendy on, 912 00:38:12,990 --> 00:38:16,440 I think it's easier, 'cause she's very comfortable, 913 00:38:16,440 --> 00:38:19,417 and more than willing to grab the team and just, 914 00:38:19,417 --> 00:38:20,887 you know, kind of be like, 915 00:38:20,887 --> 00:38:22,050 "All right, this is what we're doing." 916 00:38:22,050 --> 00:38:22,883 You know? 917 00:38:22,883 --> 00:38:24,060 But if you have providers 918 00:38:24,060 --> 00:38:25,890 that haven't run simulations themselves, 919 00:38:25,890 --> 00:38:27,660 with a charge nurse who's brand new 920 00:38:27,660 --> 00:38:29,700 and doesn't feel super comfortable, 921 00:38:29,700 --> 00:38:30,720 it's, you know, 922 00:38:30,720 --> 00:38:34,980 I think our challenge is like holding people accountable 923 00:38:34,980 --> 00:38:37,983 to make them happen. 924 00:38:38,910 --> 00:38:40,383 Yeah, it's, I agree with Amelie, 925 00:38:40,383 --> 00:38:42,090 it's the human factor, right? 926 00:38:42,090 --> 00:38:43,260 You show up, 927 00:38:43,260 --> 00:38:44,670 you know, people have called out, 928 00:38:44,670 --> 00:38:46,650 people are sick, people are grumpy, 929 00:38:46,650 --> 00:38:48,150 and the floor's going crazy, 930 00:38:48,150 --> 00:38:49,920 and you just can't run a drill. 931 00:38:49,920 --> 00:38:52,410 But if you have someone who says, you know, 932 00:38:52,410 --> 00:38:55,694 if you pick a couple of drill people in your department, 933 00:38:55,694 --> 00:38:57,330 and really sit with them and train them 934 00:38:57,330 --> 00:38:58,380 till they feel comfortable. 935 00:38:58,380 --> 00:38:59,760 I think starting there, 936 00:38:59,760 --> 00:39:01,680 like get the drillers together, 937 00:39:01,680 --> 00:39:04,500 and maybe run a couple drills together as the group, 938 00:39:04,500 --> 00:39:05,333 talk about that. 939 00:39:05,333 --> 00:39:06,960 And then when I show up on the floor, 940 00:39:06,960 --> 00:39:07,793 I look around and I say, 941 00:39:07,793 --> 00:39:10,050 "Okay, is tonight gonna be a good night for a drill? 942 00:39:10,050 --> 00:39:11,910 Do I think I'm gonna be able to squeeze one in 943 00:39:11,910 --> 00:39:13,680 somewhere here?" 944 00:39:13,680 --> 00:39:15,150 Or does the staffing look good? 945 00:39:15,150 --> 00:39:16,380 How many patients do we have showing up? 946 00:39:16,380 --> 00:39:18,570 Kind of like, flexibility, 947 00:39:18,570 --> 00:39:20,490 I think the human element, and flexibility, 948 00:39:20,490 --> 00:39:21,323 and showing up and saying, 949 00:39:21,323 --> 00:39:24,240 "Okay, am I gonna be able to pull this off tonight?" 950 00:39:24,240 --> 00:39:25,800 Are the two biggest hurdles. 951 00:39:25,800 --> 00:39:27,486 It's not the information, we all like it, 952 00:39:27,486 --> 00:39:30,390 I mean we all love this stuff, 953 00:39:30,390 --> 00:39:31,560 or we wouldn't be doing what we do, 954 00:39:31,560 --> 00:39:33,690 but it's more the ability, 955 00:39:33,690 --> 00:39:35,610 the extra energy to do what you have to do 956 00:39:35,610 --> 00:39:37,110 on top of what you already have to do 957 00:39:37,110 --> 00:39:39,090 that can get to some people. 958 00:39:39,090 --> 00:39:41,070 Yeah, and like for us, 959 00:39:41,070 --> 00:39:42,840 I'm sure similar to other hospitals, 960 00:39:42,840 --> 00:39:46,170 our night shift are generally our newer nurses 961 00:39:46,170 --> 00:39:47,010 and our travelers, 962 00:39:47,010 --> 00:39:49,770 so that's the shift that needs this the most. 963 00:39:49,770 --> 00:39:52,590 And but like, I don't work night shift, 964 00:39:52,590 --> 00:39:55,740 and other leaders in the department 965 00:39:55,740 --> 00:39:57,510 are not around as much at night, 966 00:39:57,510 --> 00:39:59,850 and it's certainly not at 2:00 AM 967 00:39:59,850 --> 00:40:02,280 when you are like, "Oh, now would be a good time." 968 00:40:02,280 --> 00:40:03,113 You know? 969 00:40:03,113 --> 00:40:04,680 Sometimes I work until 11:00 PM, 970 00:40:04,680 --> 00:40:07,980 but I generally, unless there's a huge crisis going on, 971 00:40:07,980 --> 00:40:10,410 I'm not here in the middle of the night shift. 972 00:40:10,410 --> 00:40:12,970 So I think, really, 973 00:40:16,110 --> 00:40:19,950 the challenge is getting people to feel comfortable enough. 974 00:40:19,950 --> 00:40:21,090 And I think what Wendy's saying, 975 00:40:21,090 --> 00:40:23,310 like have the people who are the facilitators 976 00:40:23,310 --> 00:40:24,840 practice with each other first 977 00:40:24,840 --> 00:40:27,000 before they do them with staff nurses. 978 00:40:27,000 --> 00:40:28,260 It's very understandable, 979 00:40:28,260 --> 00:40:31,350 you wanna feel like very credible with your nursing staff. 980 00:40:31,350 --> 00:40:33,840 You know, you wanna feel like you can speak to all of it, 981 00:40:33,840 --> 00:40:34,950 and you're super well organized, 982 00:40:34,950 --> 00:40:37,350 and you're like doing this awesome activity. 983 00:40:37,350 --> 00:40:39,219 I think like lowering the bar for yourself a little bit, 984 00:40:39,219 --> 00:40:40,740 and saying, you know what, 985 00:40:40,740 --> 00:40:43,073 just getting out there talking through stuff, 986 00:40:43,073 --> 00:40:46,050 you know, creating some checklists, as we don't have them. 987 00:40:46,050 --> 00:40:50,100 There's a lot of things that you can do to support this 988 00:40:50,100 --> 00:40:51,960 without feeling like I, personally, 989 00:40:51,960 --> 00:40:54,910 have to be the one to run every single one of these drills. 990 00:40:56,095 --> 00:40:57,780 And I think another fun point is that if you, 991 00:40:57,780 --> 00:41:01,170 if we run the drills for conferences, 992 00:41:01,170 --> 00:41:02,490 we give everyone an assignment. 993 00:41:02,490 --> 00:41:05,010 So, someone's pediatric, someone's anesthesia, 994 00:41:05,010 --> 00:41:06,720 someone's resident one, 995 00:41:06,720 --> 00:41:09,750 someone's nurse, and someone's attending. 996 00:41:09,750 --> 00:41:11,400 And if you have that many people, 997 00:41:11,400 --> 00:41:12,233 you know what I'm saying, 998 00:41:12,233 --> 00:41:15,750 you could certainly assign people roles. 999 00:41:15,750 --> 00:41:19,500 But what what I found was very educational 1000 00:41:19,500 --> 00:41:23,130 for physicians in particular, is when three physicians 1001 00:41:23,130 --> 00:41:25,950 are giving one nurse orders. (laughs) 1002 00:41:25,950 --> 00:41:27,568 And I say, "Yeah, it's not fun, right? 1003 00:41:27,568 --> 00:41:29,400 You need to realize 1004 00:41:29,400 --> 00:41:32,730 that she can only process so many things at once." 1005 00:41:32,730 --> 00:41:35,730 And so that was a good part of the simulation, 1006 00:41:35,730 --> 00:41:38,490 to say, you know, that's too much for one person 1007 00:41:38,490 --> 00:41:40,080 and they're overwhelmed, 1008 00:41:40,080 --> 00:41:43,350 what do we need to do to help them do this better? 1009 00:41:43,350 --> 00:41:45,480 That can be also a part of your simulation. 1010 00:41:45,480 --> 00:41:46,640 It was very educational, 1011 00:41:46,640 --> 00:41:48,120 especially for some of the residents, 1012 00:41:48,120 --> 00:41:49,440 to realize how hard it's for a nurse 1013 00:41:49,440 --> 00:41:51,180 to take that many orders at once 1014 00:41:51,180 --> 00:41:53,480 with that many people talking at them at once. 1015 00:41:54,570 --> 00:41:56,850 Yeah, like sometimes the focus of the drill, 1016 00:41:56,850 --> 00:41:58,620 it's a postpartum hemorrhage scenario, 1017 00:41:58,620 --> 00:42:02,640 but like what I'm honing in on is team communication. 1018 00:42:02,640 --> 00:42:05,160 You know, I wanna see closed-loop communication. 1019 00:42:05,160 --> 00:42:06,270 And like so that might be 1020 00:42:06,270 --> 00:42:08,580 what I am choosing to focus on for the debrief. 1021 00:42:08,580 --> 00:42:11,129 And you can let them know ahead of time, you know, 1022 00:42:11,129 --> 00:42:14,280 we've been having a lot of issues around communication, 1023 00:42:14,280 --> 00:42:16,080 you know, if you see a slew of safe reports, 1024 00:42:16,080 --> 00:42:18,360 and communication seems to be a topic, 1025 00:42:18,360 --> 00:42:23,220 like make that a more central focus of your drills. 1026 00:42:23,220 --> 00:42:26,702 You know, you can really adapt the scenarios 1027 00:42:26,702 --> 00:42:28,170 to really meet the needs 1028 00:42:28,170 --> 00:42:30,513 of what's going on in your unit right now. 1029 00:42:33,330 --> 00:42:35,583 And be creative, be fun, you know? 1030 00:42:36,676 --> 00:42:38,670 Involve other units. 1031 00:42:38,670 --> 00:42:41,520 Make the pediatrician be the anesthesiologist, 1032 00:42:41,520 --> 00:42:44,010 or make someone be the pediatrician. 1033 00:42:44,010 --> 00:42:44,843 You know? 1034 00:42:44,843 --> 00:42:47,010 Your pediatric team can't get there for 25 minutes, 1035 00:42:47,010 --> 00:42:49,530 who's gonna resuscitate the baby? 1036 00:42:49,530 --> 00:42:51,810 Who feels comfortable doing that? 1037 00:42:51,810 --> 00:42:53,790 These are things that you can learn about each other, 1038 00:42:53,790 --> 00:42:54,623 just chat. 1039 00:42:54,623 --> 00:42:56,700 Like say, you know, "I would rather boil myself in oil." 1040 00:42:56,700 --> 00:42:57,877 But some people might say, 1041 00:42:57,877 --> 00:43:00,675 "Oh, I have tons of NICU experience, so I'll do that." 1042 00:43:00,675 --> 00:43:02,797 You know, that's a good resource then for them later to say, 1043 00:43:02,797 --> 00:43:05,310 "Hey, you've done this before, can we talk about this?" 1044 00:43:05,310 --> 00:43:08,880 So that you learn more about each other in these drills, 1045 00:43:08,880 --> 00:43:12,123 as well which can really help patient care moving forward. 1046 00:43:15,270 --> 00:43:17,640 Yeah, so I also, I teach NRP, 1047 00:43:17,640 --> 00:43:21,120 and in the NRP simulation world, at least here, 1048 00:43:21,120 --> 00:43:23,517 you know, you can have a class of 10 people, 1049 00:43:23,517 --> 00:43:25,020 and they all might be nurses, 1050 00:43:25,020 --> 00:43:27,300 or half nurses and half respiratory therapists, 1051 00:43:27,300 --> 00:43:31,980 but you still have to resuscitate a 24 weeker, so. 1052 00:43:31,980 --> 00:43:34,593 But you don't have your neonatologists, 1053 00:43:36,077 --> 00:43:38,610 and you don't have the people you would have in real life. 1054 00:43:38,610 --> 00:43:41,040 So in NRP scenarios, I think it's really, really common 1055 00:43:41,040 --> 00:43:43,470 that you're acting outside of your role, 1056 00:43:43,470 --> 00:43:44,310 and you're doing things 1057 00:43:44,310 --> 00:43:47,400 that you would not be doing in a real life scenario. 1058 00:43:47,400 --> 00:43:50,100 I try to avoid that, you know, whenever possible. 1059 00:43:50,100 --> 00:43:51,450 Running drills on the floor, 1060 00:43:51,450 --> 00:43:54,690 you have everybody there, we do, 1061 00:43:54,690 --> 00:43:56,160 obviously in community hospitals, 1062 00:43:56,160 --> 00:43:57,450 it might not be the same way. 1063 00:43:57,450 --> 00:43:59,820 But we have the members of our team, 1064 00:43:59,820 --> 00:44:03,360 so I have people do what they would do in the actual, 1065 00:44:03,360 --> 00:44:05,580 you know, real clinical environment. 1066 00:44:05,580 --> 00:44:06,870 I don't think, personally, 1067 00:44:06,870 --> 00:44:08,070 I don't think it's super helpful 1068 00:44:08,070 --> 00:44:09,300 to have people practicing stuff 1069 00:44:09,300 --> 00:44:12,390 that they actually aren't responsible for, 1070 00:44:12,390 --> 00:44:14,610 but I do think conversations around it, 1071 00:44:14,610 --> 00:44:16,860 understanding other people's skillsets, 1072 00:44:16,860 --> 00:44:18,930 and understanding the responsibility 1073 00:44:18,930 --> 00:44:21,830 of the other people on the team is super, super important. 1074 00:44:25,448 --> 00:44:27,060 [Marge] So, this is Marge, 1075 00:44:27,060 --> 00:44:30,270 did you guys talk about the question in the chat from Andrea 1076 00:44:30,270 --> 00:44:31,800 about JAYCO? 1077 00:44:31,800 --> 00:44:33,540 Oh, no, I haven't even been looking at the -- 1078 00:44:33,540 --> 00:44:35,790 [Marge] Okay, I just was wanted to address it. 1079 00:44:35,790 --> 00:44:36,690 I didn't think you did, 1080 00:44:36,690 --> 00:44:38,610 but I had to take a phone call, 1081 00:44:38,610 --> 00:44:40,260 so I might have missed something. 1082 00:44:43,350 --> 00:44:44,640 I see, yeah, so this -- 1083 00:44:44,640 --> 00:44:46,800 [Marge] What you need to do for JAYCO, 1084 00:44:46,800 --> 00:44:49,980 you do need to prove your education 1085 00:44:49,980 --> 00:44:54,390 every two years for JAYCO, for hemorrhage and hypertension. 1086 00:44:54,390 --> 00:44:55,983 That's the cornerstone. 1087 00:44:58,080 --> 00:45:02,070 That is Amelie's other favorite project, 1088 00:45:02,070 --> 00:45:04,593 I know since we worked on it for like three years. 1089 00:45:07,620 --> 00:45:12,030 The fact that you have drills is required by JAYCO, 1090 00:45:12,030 --> 00:45:13,590 but you don't have to document 1091 00:45:13,590 --> 00:45:17,820 that you have run all of your staff through drills 1092 00:45:17,820 --> 00:45:20,370 as an individual at any time. 1093 00:45:20,370 --> 00:45:22,320 Does that answer your question, Andrea? 1094 00:45:24,990 --> 00:45:25,830 [Andrea] Yes, absolutely. 1095 00:45:25,830 --> 00:45:29,010 I was looking at like the prizes and everything, 1096 00:45:29,010 --> 00:45:30,349 and I thought those are all great ideas, 1097 00:45:30,349 --> 00:45:31,447 and then I'm like, 1098 00:45:31,447 --> 00:45:34,080 "Man, like it's just gonna be challenging 1099 00:45:34,080 --> 00:45:35,190 to kind of get everyone." 1100 00:45:35,190 --> 00:45:37,050 And I was trying to review those standards, 1101 00:45:37,050 --> 00:45:38,790 but really appreciate that. 1102 00:45:38,790 --> 00:45:39,623 Thank you. 1103 00:45:39,623 --> 00:45:40,456 [Marge] Yeah, no way. 1104 00:45:40,456 --> 00:45:43,020 I think the main thing is, for all providers, 1105 00:45:43,020 --> 00:45:46,020 and just to remind you that, the cornerstone, 1106 00:45:46,020 --> 00:45:48,750 which, again, we're happy to share with anybody, 1107 00:45:48,750 --> 00:45:51,180 has to be not just for all OB providers, 1108 00:45:51,180 --> 00:45:55,770 and I'm talking about docs, midwives, nurses, 1109 00:45:55,770 --> 00:45:58,500 it also includes anesthesiology, 1110 00:45:58,500 --> 00:46:00,210 and even more complicated, 1111 00:46:00,210 --> 00:46:04,380 it includes the emergency room docs and nurses. 1112 00:46:04,380 --> 00:46:06,153 That is a big lift. 1113 00:46:08,250 --> 00:46:09,100 [Andrea] Right. 1114 00:46:13,467 --> 00:46:15,150 And one thing that I've done, 1115 00:46:15,150 --> 00:46:17,130 you know, in order to ensure, 1116 00:46:17,130 --> 00:46:18,510 like it's impossible to make sure 1117 00:46:18,510 --> 00:46:20,640 that every single person participates in a drill, 1118 00:46:20,640 --> 00:46:25,200 but I do a drill is not the same as a simulation, 1119 00:46:25,200 --> 00:46:26,430 like the terminology, 1120 00:46:26,430 --> 00:46:30,090 drill is means it's like on the unit, it's in SISU, 1121 00:46:30,090 --> 00:46:31,020 it's in the environment 1122 00:46:31,020 --> 00:46:33,240 where you're providing care to patients, 1123 00:46:33,240 --> 00:46:36,330 whereas a simulation can happen in a lab, 1124 00:46:36,330 --> 00:46:39,033 in a sim lab, or you know, in a conference room. 1125 00:46:40,740 --> 00:46:45,740 So all of our nurses on labor and delivery and postpartum, 1126 00:46:46,020 --> 00:46:48,060 you know, participate in education days 1127 00:46:48,060 --> 00:46:51,210 where we will do one of these topics every other year, 1128 00:46:51,210 --> 00:46:52,620 so that like every other year, 1129 00:46:52,620 --> 00:46:54,270 they're reviewing postpartum hemorrhage 1130 00:46:54,270 --> 00:46:56,580 and hypertension scenarios, 1131 00:46:56,580 --> 00:46:59,710 and then everyone also gets the cornerstone module 1132 00:47:00,655 --> 00:47:02,103 loaded as well. 1133 00:47:09,480 --> 00:47:11,100 Any other questions? 1134 00:47:11,100 --> 00:47:12,963 I have not been looking in the chat. 1135 00:47:18,690 --> 00:47:21,570 Yes, Leah's top comment is absolutely true. 1136 00:47:21,570 --> 00:47:25,800 Like, you can definitely frame these as a way, 1137 00:47:25,800 --> 00:47:28,000 you know, it's a way to explore 1138 00:47:29,040 --> 00:47:31,290 if there are gaps in your system. 1139 00:47:31,290 --> 00:47:33,780 And that really is the true intent, 1140 00:47:33,780 --> 00:47:36,240 it's why you are supposed to run them on the unit 1141 00:47:36,240 --> 00:47:38,640 using the systems that you actually have in place, 1142 00:47:38,640 --> 00:47:39,660 so that you can identify 1143 00:47:39,660 --> 00:47:41,280 where there's a glitch in the system, 1144 00:47:41,280 --> 00:47:44,220 or where you need to rethink how you're doing things. 1145 00:47:44,220 --> 00:47:46,620 Running through these drills identifies like, 1146 00:47:46,620 --> 00:47:47,970 is there an issue with the blood bank, 1147 00:47:47,970 --> 00:47:50,170 do we have a problem with the paging system? 1148 00:47:51,090 --> 00:47:52,980 So you can bring things to light sometimes 1149 00:47:52,980 --> 00:47:57,003 that you otherwise might not have an opportunity to see. 1150 00:47:58,140 --> 00:48:01,002 And you know, I just can't emphasize enough, 1151 00:48:01,002 --> 00:48:06,002 you know, perfection's the enemy of the good. 1152 00:48:06,330 --> 00:48:07,413 Some days, 1153 00:48:08,250 --> 00:48:11,430 all you can bring yourself to do 1154 00:48:11,430 --> 00:48:14,647 is to get a cup of coffee and be like, 1155 00:48:14,647 --> 00:48:17,730 "Where are those hypertension medications?" 1156 00:48:17,730 --> 00:48:22,730 You know, "How do we do an MTP?" 1157 00:48:23,010 --> 00:48:25,590 Honestly, I consider those inside your drills, 1158 00:48:25,590 --> 00:48:27,300 you do not have to do a whole drill, 1159 00:48:27,300 --> 00:48:29,040 it's not all or nothing. 1160 00:48:29,040 --> 00:48:31,740 Literally, if you're sitting around being like, 1161 00:48:31,740 --> 00:48:35,280 let's sing a song, we don't do very much, right? 1162 00:48:35,280 --> 00:48:37,950 How do we quick page pedes, 1163 00:48:37,950 --> 00:48:40,380 how do we activate a shoulder dystocia? 1164 00:48:40,380 --> 00:48:42,900 All of those things, as far as I'm concerned, 1165 00:48:42,900 --> 00:48:46,152 if you ask a question, run through a scenario, 1166 00:48:46,152 --> 00:48:48,780 and you can then have a little conversation, 1167 00:48:48,780 --> 00:48:51,180 also known as a debrief, about it, 1168 00:48:51,180 --> 00:48:52,380 you click that off, 1169 00:48:52,380 --> 00:48:55,050 you've slide it under your nurse manager's pen, 1170 00:48:55,050 --> 00:48:56,970 and get yourself a prize. 1171 00:48:56,970 --> 00:49:00,120 Because these are just the way 1172 00:49:00,120 --> 00:49:02,940 that every day with these little things. 1173 00:49:02,940 --> 00:49:04,368 So don't, 1174 00:49:04,368 --> 00:49:09,090 we have to just move this mindset of it's like a giant thing 1175 00:49:09,090 --> 00:49:10,650 or you don't do it, 1176 00:49:10,650 --> 00:49:14,130 literally a 15 minute conversation about, 1177 00:49:14,130 --> 00:49:16,920 where do get the meds, the order to push them, 1178 00:49:16,920 --> 00:49:19,800 and to discuss the little debrief, 1179 00:49:19,800 --> 00:49:21,990 or what's funny or interesting about it, 1180 00:49:21,990 --> 00:49:24,893 that counts 100%. 1181 00:49:36,330 --> 00:49:38,040 I will add that, in your drill binders, 1182 00:49:38,040 --> 00:49:39,300 we have scavenger hunts. 1183 00:49:39,300 --> 00:49:40,290 Those are always good 1184 00:49:40,290 --> 00:49:42,360 if you just don't feel like doing a drill, 1185 00:49:42,360 --> 00:49:44,700 so you can just find stuff on the unit. 1186 00:49:44,700 --> 00:49:47,520 Not that anybody wouldn't know where anything is on a unit, 1187 00:49:47,520 --> 00:49:49,620 like the new scalp electrodes 1188 00:49:49,620 --> 00:49:51,420 that actually come out of the baby's heads. 1189 00:49:51,420 --> 00:49:52,770 Who knows where those are? 1190 00:49:52,770 --> 00:49:54,060 Oh, you have to ask Amelie. 1191 00:49:54,060 --> 00:49:56,223 So, those kinds of things. 1192 00:49:58,053 --> 00:50:01,410 And I feel like at night, that is a really big issue, 1193 00:50:01,410 --> 00:50:04,470 the the Easter egg hunt of, you know, 1194 00:50:04,470 --> 00:50:05,910 I need a banjo curet, 1195 00:50:05,910 --> 00:50:07,050 and then I have a new LDA 1196 00:50:07,050 --> 00:50:09,183 that has no idea what I'm talking about. 1197 00:50:10,560 --> 00:50:12,240 [Marge] Or where's the clock on the wall? 1198 00:50:12,240 --> 00:50:13,650 Where's the clock on the wall? 1199 00:50:13,650 --> 00:50:15,753 How do I mark time? 1200 00:50:15,753 --> 00:50:18,423 How do I get her this thingy babobber that she wants? 1201 00:50:20,100 --> 00:50:22,110 Did CSR put it in the right packaging? 1202 00:50:22,110 --> 00:50:24,030 Did it actually get back where we're supposed to go? 1203 00:50:24,030 --> 00:50:25,170 You know, all those things, 1204 00:50:25,170 --> 00:50:28,320 they're system errors or system processes that, 1205 00:50:28,320 --> 00:50:30,180 you know, somebody new didn't know, 1206 00:50:30,180 --> 00:50:33,750 or put it somewhere that nobody knows where it is. 1207 00:50:33,750 --> 00:50:35,973 That's a simulation too, that's a drill too. 1208 00:50:52,530 --> 00:50:57,530 [Marge] But mostly guys, if you need anything, 1209 00:50:58,170 --> 00:51:01,590 I will tell you, we have developed so much stuff, 1210 00:51:01,590 --> 00:51:05,910 so certainly if you feel the need to develop it yourself, 1211 00:51:05,910 --> 00:51:07,893 you are always welcome. 1212 00:51:10,879 --> 00:51:14,370 but you are welcome to just shoot me an email 1213 00:51:14,370 --> 00:51:15,933 if you need something, 1214 00:51:16,980 --> 00:51:19,560 because 9 times out of 10, 1215 00:51:19,560 --> 00:51:22,860 we have something that, if it's not exactly what you need, 1216 00:51:22,860 --> 00:51:24,780 it's super close. 1217 00:51:24,780 --> 00:51:27,210 And honestly, if you ask me and I don't have it, 1218 00:51:27,210 --> 00:51:30,420 it probably means that we do need it anyway, 1219 00:51:30,420 --> 00:51:31,860 and so we can help. 1220 00:51:31,860 --> 00:51:34,770 So I just wanna emphasize to please, 1221 00:51:34,770 --> 00:51:38,070 anything that is funny about implementation or these drills, 1222 00:51:38,070 --> 00:51:39,390 please let us know. 1223 00:51:39,390 --> 00:51:40,320 And thanks, Julie, 1224 00:51:40,320 --> 00:51:45,320 there is the reminder about the next AIM team webinar, 1225 00:51:46,710 --> 00:51:50,310 and we're just gonna go a little deeper than we have, 1226 00:51:50,310 --> 00:51:53,790 going into with the hypertension rollout, 1227 00:51:53,790 --> 00:51:57,663 which is substantially easier than the hemorrhage one. 1228 00:51:58,881 --> 00:52:01,110 Now, just email me if anybody has any questions, 1229 00:52:01,110 --> 00:52:01,943 you guys do it, 1230 00:52:01,943 --> 00:52:03,660 you know how to find Julie, 1231 00:52:03,660 --> 00:52:05,820 you know how to find Sam, 1232 00:52:05,820 --> 00:52:07,890 thankfully, Julie's doing an excellent job 1233 00:52:07,890 --> 00:52:09,600 keeping me in line, 1234 00:52:09,600 --> 00:52:12,660 but Sam does whack me down a little more, 1235 00:52:12,660 --> 00:52:14,410 'cause she's right across the hall. 1236 00:52:15,360 --> 00:52:16,713 But you know, let us know. 1237 00:52:21,480 --> 00:52:23,670 Oh, do I have a good recipe for blood? 1238 00:52:23,670 --> 00:52:27,933 I mean, the blood that I make makes a huge mess. 1239 00:52:28,860 --> 00:52:33,123 I got it online, it stains participants, 1240 00:52:34,290 --> 00:52:37,380 so (laughs) I don't know if I would use my recipe. 1241 00:52:37,380 --> 00:52:38,370 The first time I did it, 1242 00:52:38,370 --> 00:52:40,530 one of our nurses was the patient, 1243 00:52:40,530 --> 00:52:43,417 and like three days later she texted me, she was like, 1244 00:52:43,417 --> 00:52:45,706 "My perineum is still bright red." 1245 00:52:45,706 --> 00:52:48,360 (Wendy laughing) 1246 00:52:48,360 --> 00:52:49,950 Like, sorry! 1247 00:52:49,950 --> 00:52:51,613 So. (chuckles) 1248 00:52:51,613 --> 00:52:53,680 Okay, the first thing for all of it, 1249 00:52:53,680 --> 00:52:56,094 don't look down there! 1250 00:52:56,094 --> 00:52:57,810 (Amelie laughing) 1251 00:52:57,810 --> 00:52:59,430 Yes, exactly. 1252 00:52:59,430 --> 00:53:02,220 But now I just like put blood, 1253 00:53:02,220 --> 00:53:04,050 fake blood on a chucks, and like, 1254 00:53:04,050 --> 00:53:06,870 I just use the same fake bloody chucks every time, 1255 00:53:06,870 --> 00:53:11,130 I don't necessarily like soak the patient 1256 00:53:11,130 --> 00:53:12,573 in fake blood anymore. 1257 00:53:19,710 --> 00:53:21,600 Amelie, if you find another recipe, 1258 00:53:21,600 --> 00:53:24,720 you can always send it my way, 1259 00:53:24,720 --> 00:53:26,850 and then I can share with this group. 1260 00:53:26,850 --> 00:53:27,683 Okay. 1261 00:53:29,460 --> 00:53:31,800 I didn't know there was recipe for making blood, 1262 00:53:31,800 --> 00:53:34,470 that's interesting. (chuckles) 1263 00:53:34,470 --> 00:53:38,310 Yeah, and it's all like, edible ingredients actually. 1264 00:53:38,310 --> 00:53:41,523 I don't recommend eating it, but. (chuckles) 1265 00:53:46,470 --> 00:53:47,970 Well, thanks for having us. 1266 00:53:47,970 --> 00:53:49,563 I hope this was helpful. 1267 00:53:52,770 --> 00:53:54,270 Thank you guys, let us know if you need help you at all. 1268 00:53:54,270 --> 00:53:55,103 Thank you. 1269 00:53:57,690 --> 00:53:58,830 Yes, here to help, 1270 00:53:58,830 --> 00:54:00,080 you can always reach out. 1271 00:54:03,084 --> 00:54:04,284 Have a good day, guys. 1272 00:54:07,530 --> 00:54:09,270 Thank you, Julie. 1273 00:54:09,270 --> 00:54:11,190 -Yeah, thank you, Julie. -For setting us all up. 1274 00:54:11,190 --> 00:54:12,863 -Thank you. -Thank you.