To improve outcomes and combat the rising costs of providing health care and the penalties for hospital readmissions, Jump Simulation, a part of OSF Innovation, is developing a new way to train clinicians on wound treatment in partnership with a clinical Mission Partner.
“This was developed in support of a Ministrywide refocus on wound prevention, identification and treatment,” said Melissa Pokarney, simulation program development specialist with Jump. “Pressure sores are a preventable complication of immobility, device use or both. A renewed focus in this area improves patient safety and reduces costs.”
Marjorie Oliver, a clinical education scholar with the Critical Care Division at OSF HealthCare Saint Francis Medical Center in Peoria, came up with the idea of providing a traveling skills station where nurses can practice identifying and staging pressure ulcers and wound treatment skills. She enlisted the help of the engineering team and simulation specialists at Jump Trading Simulation & Education Center in Peoria to bring her idea to life.
How the wound program developed
The concept was to develop a training cart or traveling skills station with simulated wounds for clinicians to practice wound treatment. Facilitators would have learners do a complete head-to-toe assessment, stage any wounds and then choose various treatment options.
Wounds are diagnosed in stages: stage 1, the skin is intact but no longer blanches, through stage 4, where the wound goes all the way to the bone. Some wounds aren’t staged – the wound is there, but it’s not clear how deep it goes.
“We enlisted one of our moulage experts, Leann Gilles, who created several realistic wounds on a static manikin for deployment via the traveling skills station,” Melissa said.
The idea kept developing, and the realism and types of wounds expanded with a focus on blanching and non-blanching wounds. Blanching is when the skin turns pale, which can indicate a restriction or obstruction in blood flow.
“Our team went through a few iterations of the manikin to improve the realism of the moulage,” Melissa said. “Early inclusion of the Jump engineering team and their interns to focus on creating blanching and non-blanching wounds, as well as realistic blisters and un-stageable wounds, brought this station up to the next level.”
To simulate blanching, the team at Jump added a little fluid between the layers of silicone “skin,” so when pressed, the fluid disperses and reveals a lighter color of “skin” before the darker red fluid fills back in.
“The non-blanching (stage 1) models feel the same, but there’s no color change, just like an actual stage 1 pressure sore,” Melissa said.
The new wound models were affixed to the manikin, and Melissa ensured that the case studies involved the improved pieces.
Rolling out the program
The idea was embraced by OSF and is in the early stages of development for Ministrywide deployment. The skills stations will be placed on the nursing floors for easy access.
“So far, critical care nurses and patient care technicians (PCT) at OSF Saint Francis have benefitted from the station. In the near future, nurses and PCTs in all of OSF regions and service lines will benefit from this education,” Melissa said.
Jump is working with Ministry educators to determine the best way to deploy the stations in a sustainable, consistent and space-conscious way. This has led to the development of a virtual model which can be viewed through an augmented reality application on mobile phones or similar handheld devices.
Benefits of the program
The engagement and willingness of nursing management teams to be facilitators of the skill station led to maximized effectiveness and minimized impact on the nursing workday.
“Learners get the benefit of seeing and discussing documentation, treatment and prevention in an interactive environment on their unit,” Melissa said. “They don’t need to sign up for a course outside working hours.”
So far, Melissa said that among the 207 learners who completed the post-session survey, the average change in learner self-confidence in their ability to identify, treat and implement preventive measures improved from 68% to 84%.
“Interactive learning improves information retention,” Melissa said. “Learners in small group discussions tend to ask questions that expand the topic for the others in the group.”