1. Moulage: Nuts & Bolts Krista Kipper BSN, RN HealthPartners Clinical Program Manager

2. Clinical education that measurably improves care.  Moulage – The artistic technique of incorporating realistic cues, such as wounds, perspiration, blood, or therapeutic devices, to increase the “psychological fidelity” of a simulation. Moulage

3. Clinical education that measurably improves care.  Alignment with objectives  Participant considerations – Level of experience – Environment – Inter-professional education  Subject – Human – Mannequin  Knowledge – Physiology of the situation – Mechanism of injury Considerations

4. Clinical education that measurably improves care. What do you need?

5. Clinical education that measurably improves care.  Wigs – Halloween purchase  Wounds & Incisions – Halloween purchase  Eye Shadows & Blushes – Many colors  Make-up brushes  Water Color markers  Finger paints  Distilled water  Dish detergents – Blue – White – Pink/red  White shaving cream  Red bubble wrap  Red plastic food wrap – Winter holiday purchase  Food coloring Moulage Supplies

6. Clinical education that measurably improves care.  Artificial blood  Spray bottle – Distilled water to spray diaphoresis – Scented concentrate  Liquor/alcohol  Fruity for DKA breath  Adhesives – Tapes – Tegaderm Moulage Supplies cont…  “White” eraser  Powder

7. Clinical education that measurably improves care. Body Fluids Magic

8. Clinical education that measurably improves care. Moulage Supplies cont…  Mixing Basics – Secure locking containers – Spoons – Leur-lock syringe – Cath tip syringe – Drainage bags for IV fluids – Funnels – Measuring cups

9. Clinical education that measurably improves care.  Avoid – Mold Growth Food Products?

10. Clinical education that measurably improves care.  Possible Exceptions: – No direct contact with mannequin  Edema: Cream of wheat/oatmeal in secured bags covered with nylons  Coffee grounds added to a fluid presented in a basin – Cornstarch for thickness – Rice crispies/broken chips in a baggie for crepitus – Plain gelatin with red food coloring for clots Food products?

11. Clinical education that measurably improves care.  Benefits – Blending make-up for bruises is easier – Adhesives stick better – Individual can assist with device or moulage – Individual can assist with clean up – Realistic facial expressions and movement Human Subjects

12. Clinical education that measurably improves care.  Limitations: – Need breaks – May have allergies to moulage/device materials – Inability to perform all “critical actions” when simulating a medical emergencies (ie. Intubate) – Limitations to the application of devices (ie. Foley) – Limitations related to exposure Human Subjects

13. Clinical education that measurably improves care.  Benefits – More realistic device application (ie. Intubation) – Easy exposure – Ability to alter physiological findings – No allergic concerns – No timing issues related to breaks Mannequin Subjects

14. Clinical education that measurably improves care.  Limitations: – Lack of movement & facial expressions – Devices do not fit realistically – Surface staining – Realistic blending of make-up is challenging – Variances' to the adhesive qualities of materials Mannequin Subject

15. Clinical education that measurably improves care. HumanMannequin Example of Bruises

16. Clinical education that measurably improves care. Example of Bruises

17. Clinical education that measurably improves care. Example of Wounds

18. Clinical education that measurably improves care. Example of Wounds

19. Clinical education that measurably improves care. Example of Burns

20. Clinical education that measurably improves care. Example of Burns

21. Clinical education that measurably improves care.  Basic device needs – Dressings – Basins – Drainage collection devices  IV infusion over flow  Foley  Stool collection device – Medications – Intravenous supplies – Chux – Armbands – Oxygen flowmeter – Oxygen Adjuncts Moulage Supplies cont….

22. Clinical education that measurably improves care. Additional medical device considerations: – Bag valve mask – Splints – C-collar – Backboard – Traction – Chest tubes – JP bulbs – IV pumps – Feeding pumps – Feeding tubes – Suction Canister – Yankeur THE LIST IS ENDLESS!!! Medical Supplies cont…

23. Clinical education that measurably improves care.  Use expired materials (ie. Medications, defib pads)  Repackage materials (ie. Cath kits, central line kits)  Predetermined disposal site  Make friends with ancillary departments (ie. Pharmacy, Biomed, Materials)  Refill & Reuse… Reuse… Reuse Show me the money!!!

24. Clinical education that measurably improves care.  Meconium – Green finger paint – Yellow finger paint – Blue dish detergent Mix finger paints, adding until desired color. Add dish detergent for color and consistency. Sample Recipe

25. Clinical education that measurably improves care.  Liquid C-diff Stool – ½ cup Corn starch – 2 tsp Shaving cream – Black finger paint – Green finger paint – Red finger paint – 2 drops green food coloring – 1 drop red food coloring – Blue dish detergent Pour distilled water into a bowl for the approximate amount of stool, add green and red finger paints to make a brown color, add a tiny amount of black finger paint and food coloring. Mix corn starch, shaving cream, and blue dish detergent for realistic consistency. Sample Recipe

26. Clinical education that measurably improves care.  Blood Clots – 1 box Gelatin – Food coloring – Water  Mix according to box directions but use half as the amount of water. Add food color until desired color obtained. Pour into a cake pan (9x13). Place in refrigerator overnight to settle. Sample Recipe

27. Clinical education that measurably improves care.  Bruise – New – Older  Oozing blood  Make the moulage needed for your simulation Assignment