1. Scenario-Based Learning Used for Orientation to a New Adult Blood and Marrow Transplant Unit Karen Harden MS, RN, AOCNS, Katy Gudritz MS, RN, Cortney Dennis BSN, RN 7 West - Adult BMT Inpatient Unit - University of Michigan, Ann Arbor, MI Methods Results Purpose T he purpose of this project was to provide orientation to all nurses and techs moving to a new unit. Orientation focused on navigating the new large unit and learning to function in the new space. Background Typically orientation on our unit consists of written resources and many weeks of one to one partnership with a designated small group of preceptors. By working closely with a preceptor, new nurses are able to see tasks and procedures modeled and eventually the new nurse takes on more responsibility for completing the work independently. In our situation, all nurses knew how to care for patients, but not necessarily in the new space. We would be required to teach nurses how to navigate the new unit and learn how to get their job done in an unfamiliar environment. Essentially, their entire work flow would change. One major challenge was that there were no patients and each individual nurse would be required to teach themselves how to become comfortable on our new unit and be ready to care for patients on day ONE. Overcoming the Challenge Support of the management team, including scheduling all staff to attend, allowed for this extensive training to take place and was a foundation to our success. Early in our training the building was still under construction and hard hats, goggles and proper attire were required. This made conditions for learning a little more challenging. The intensive care unit would now be 15 minutes away –Mock emergency situations were practiced and refined. We went from one Omnicell for medications to five for the unit. There were challenges about being the only adult unit in a pediatric hospital. Acknowledgements Using a multimodal approach we wanted nurses to have fun, become familiar with the unit in a relatively short period of time and to identify individually what there own needs were to begin feeling prepared to care for patients on the new unit. Nurses were given 12 hours of formal orientation to the new unit. Additionally, they were encouraged to spend as much extra time on the unit as they felt they needed to learn their way around. Power Point presentation to orient nurses to features of the new hospital and unit. Guided Unit Tour/self guided hospital Tour – handheld maps provided Various hands-on sessions to orient to new equipment and technology (monitors, TV-computer-patient education system, call lights, hand-held phones, mock codes, fire safety). Scenario-based simulations of patient care activities including use of new call light and personal phones while completing patient care activities. Nurses were required to move throughout the unit to discover the location of equipment and supplies that would be needed for care. Activity West Side Central Link East End Administration of pRBCs – retrieve blood products from tube system Store patient belongings into room Chemotherapy Administration Mange a Chemo spill Time to take your break Patient requesting ice water Bed linen change Call for Double-check TPN/Lipids administration Lab draw needed Your phone is not programmed to your room correctly – go see your clerk Disposing of empty glass bottles, used blood tubing. Chemstick Prn medications Administration of scheduled meds A visitor asks you to get their parking badge stamped Your manager wants to see you in her office Help patient into the shower – wrap central line and provide supplies The balloon man has arrived with a package for patient in room 43 how do you find out who the nurse is A service person is looking for the unit host – please direct them Patient is ready for lunch You need a bathroom break – find a staff toilet Your patient needs to be bladder scanned – where is the scanner Need help with your MLearning – find the ENC office Your patient needs their I & O sheets and blood count sheet The patient is requesting to see their BMT physician Patient requesting food tray to be removed from room Patient is newly placed in contact precautions (signs, equipment, patient education) Patient wants your help decorating her room (discussion to patient about tacks and tape on walls Post nurse and tech names and date for patient (special marker, special board) Patient leaving for a CT scan requires wheel chair and oxygen A visitor arrives to unit not badged – how will you direct them Pt. wants to eat their leftovers from yesterday You need to order an IV pole for your patient with Omni pump Clinical Activities Checklist Navigate the unit to find items needed to accomplish the following tasks for your patient. Simulate care activities without using actual resources. Travel to all areas and think about how you would do your work, what you will need and where you need to go. The more real you make the scenario, the better your learning experience will be. Welcome to 7West! 100% staff trained (nurses, techs, clerks and unit host) Feedback sessions yielded pages of staff feedback about what they liked, what concerned them and how we could make positive changes Successful arrival of all patients from previous unit on move day Staff began caring for patients on one unit and continued on the new unit Trouble shooting and problem solving continued in the early weeks Staff played an integral role in identifying problems and creating solutions Thanks to the entire 7W staff for their dedication to making this move a huge success Manager, Carol Kristofik and Supervisor, Jill Gibbons led this team and managed many of the details Thanks to all other support services in our institution, who added to the success of our move.