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“Our students’ future needs depend on having confidence using an Electronic Health Record (EHR),” says Barbara Doss, BSN, RN, COHN, simulation and skills lab instructor at California State University (CSUEB), East Bay. Doss sees SimChart® as the ideal avenue for gaining that confidence. “SimChart is made for students,” she says. “When students go into a clinical site, they are looking at an EHR that is not made for an educational experience. When they are in the skills or simulation lab they can practice in a realistic system made for them.”
The faculty at CSUEB wanted to add EHRs to their nursing program. They started using the Simulation Learning System (SLS) in 2009, and in September 2012, added SimChart.
To determine how the faculty and students could reap the most benefit from SimChart, “We worked as a team before classes started,” says Barbara Maerz, MSN, RN, CCRN, Simulation Coordinator. The other members of the team were Doss and Erik Ruhe, BSN, RN, PHN, Skills Lab Coordinator.
The team planned how to introduce SimChart to students in the simulation and skills labs. Second-year students, who were already familiar with SLS, reviewed the student resources handbook for SimChart before faculty discussed the program in class. First-year students complete a training session for SLS and SimChart.
“The students are able to pick up SimChart very quickly,” says Ruhe. Students also use online resources for SimChart to help them integrate their learning.
Doss, Maerz, and Ruhe have successfully integrated SimChart in the simulation lab. Students complete the Pre-Simulation Manager prior to class. During prebriefing, students share part of that documentation by discussing diagnosis, medications, and laboratory results with the group.
During the simulation, “We encourage students participating in the scenario to by chart at the point of care,” Maerz says. “They can chart vital signs and their head-to-toe assessment as they are performing the simulation.”
Student observers note what would be documented into SimChart. For example, when a patient experiences respiratory distress, the observers think how those findings would be documented appropriately, including comments and vital signs. Students may also follow along by accessing the medication administration record through their electronic tablets because they are not able to directly see the medication administration record (MAR). Some observers even use their laptop computers or electronic tablets to chart during the simulation, Ruhe adds. These activities help students “feel more involved in the process, so it makes for a richer debriefing experience,” Maerz says.
After the simulation, students summarize the events of the scenario. “I focus on discussing what was easy for them to do and what were challenges,” says Maerz. “I make sure they are performing all the safety pieces along with the Electronic Health Record.” For example, in addition to scanning a barcode before medication administration, students must check the patient’s name verbally and by checking the wristband.
As mentioned, both student participants and observers document in SimChart, and submit assignments for grading. “We use SimChart each step of the way,” Doss summarizes, “Pre-simulation, during simulation, and after simulation.” She often feels “very rewarded” when she reviews students’ documentation because their work reflects “they have a very good comprehension of how to chart in an EHR.”
Faculty also use SimChart in the skills lab. For example, students log into a scenario created for the lab and document their systems assessment in SimChart in their physical health assessment course.
Doss, Maerz, and Ruhe have found SimChart also helps students learn documentation requirements for medication administration and other skills in the skills lab. “Students log into the skills drill; pull up a patient’s electronic health record, medication administration record, and doctor’s orders; then deliver the medication using the bar code,” Doss explains. Students can document what they do in the 90 skills drills in SimChart, including blood transfusion administration, suctioning a patient’s tracheostomy, or giving oral care. She adds, “Students get the complete picture of the skill when it’s connected to a patient’s name and a patient’s chart.”
The final step to full integration of SimChart is orienting other faculty members to use it in didactic classes and in clinical instruction, which is in process. “That will bring it all together,” says Doss, who sees the gradual phase-in of products an advantage that Elsevier provides. “You don’t have to implement the full product all at once. You can take them in pieces and have a successful implementation.”
“Our faculty has seen how successful we’ve been in our simulation and skills labs,” Doss continues, “and I think they’re ready to see how that can be carried over to doing a case study in SimChart in their theory course or assigning students to do their preclinical work in SimChart.”
“We use SimChart’s barcoding capabilities and feel that it has made our simulations more realistic and rewarding for the student,” says Ruhe. The barcoding is paired with a mobile workstation that faculty and students use in the simulation and skills labs. To fit the barcodes to the medication vials used in the simulations, Ruhe uses a software program to print codes that better fit the vials and still work with SimChart. “SimChart has done an excellent job of creating a realistic experience for students,” he says.
Students use barcoding in both simulation and skills labs. The students pull out the medication from a medication-dispensing unit while looking at the patient’s medication administration record. They scan the medication, take it to the bedside and scan it again in SimChart, then administer and record the administration. “Most of the hospitals are using barcoding so to have that feature is really beneficial to students,” Ruhe says.
“We feel using barcoding is appropriate because that’s what students are using when they go to their clinical sites,” Doss adds. “We’re getting wonderful positive feedback from our students,” she adds. “They see nurses giving medication using the barcode scanning and say, ‘I feel so fortunate that I was able to use SimChart and the equipment the skills lab provided me to learn how to use barcoding.’”
Doss, Maerz, and Ruhe say the benefits of SimChart start even before students graduate. “We find that facilities are more likely to give us preference when it comes to clinical sites because they know our students have practiced charting in an EHR and are confident doing so,” says Doss.
SimChart also lays the groundwork for a successful professional experience, beginning with that all-important first job. “We feel by giving our students the opportunity to learn electronic documentation, they will be more marketable when they are interviewing,” Maerz says.
Doss adds that learning electronic documentation is more than just charting on the computer. “SimChart facilitates the student’s need to practice in a chart that was made to be part of their education and to experience how they are going to incorporate the chart into their workflow at the bedside,” she says. Mastering SimChart and the tool of an EHR, “will help improve patient care and outcomes.”
The members of the faculty team using SimChart praise what the program brings to the teaching—and learning—partnership. “We feel SimChart has made a difference in the way we teach in our skills and simulation lab,” says Ruhe. “When we use SimChart and the SLS to teach the hands-on skills of charting and medication administration, our students are better prepared for their clinical work.”
“We are adapting our curriculum to meet students future needs by adding SimChart.” Doss concludes.