Too good to be true: New training device, Pat Sim, making PAH safer, more efficient

PUNXSUTAWNEY — So many little boys and girls are now familiar with the term simulator, having grown up in an era where flight simulators and simulation games are a regular thing surrounding them. But at Punxsutawney Area Hospital (PAH), there's a new simulator in town, and this one's designed for the adults.

His (or her, as he/she has removable/addable body parts to be worn or not on any given day) name is Pat Sim, and according to Lisa Wanchisn, PAH education trainer, the scope of possible training scenarios has been broadened by a large amount with Pat's arrival at the hospital.

"It's sort of like a flight simulator," she said, "where they put someone in something that looks like an actual plane and teach them to fly. It gives us an opportunity to recreate scenarios for clinicians so that they can practice and fine tune their skills. Then, they can debrief and figure out what they should do better the next time."

With the price of such a training device being quite astronomical, Wanchisn said that PAH had some help from an organization it's worked closely with — its liability insurance carrier, CHART.

According to the company's website, CHART "is dedicated to improving patient safety and reducing medical errors. It translates information into solutions and makes consulting, data management and training resources available at no cost to member hospitals. In turn, it builds safer institutions."

In commenting on CHART, Wanchisn echoed many of the points laid out by CHART itself.

"This was not purchased by us," she said. "Our liability insurance carrier, CHART, decided to initiate a program that would help clinicians refine their skills rather than to just tell us that we need to do it better. They track areas where we do the best work, and they said, ‘Let's give tools to the hospitals to help make them safer, better places for patients to be.’

"Since 2010, they've given four simulators to area hospitals about every four months. We were a part of year No. 2, and they'd already given away quite a few simulators by that point. We just got ours in December (2012), and it has been a marvelous thing. It's really something, and all they ask is that we put the piece of equipment they've provided us with to good use."

As she described the scope of Pat Sim's training purposes, Wanchisn said that the possibilities really are seemingly endless.

"We can use it for anyone in the hospital," she said. "We can extend it to our staff, from nurses to radiology techs, and the likes. But we can also use it for students coming in and for our volunteers to help give them the training that they need to be a part of what we do here."

And no matter who is using the training device, Wanchisn said that they'll walk away from it more prepared than they arrived.

"Pretty much, because the simulator has so many different features, it really can be of use to anyone, depending on what they're after," she said. "If I'm a phlebotomist, and I want to refine my technique, I can actually prime Pat's arm with colored water, and we can stick the patient with an actual needle to get a flash."

One of the best features for training, Wanchisn said, is that Pat's room comes equipped with a camera, allowing trainees to see themselves in action after the fact and to assess their own performances.

"They can watch and critique how they did on their own after they're done instead of us saying, 'You touched your hair before you touched the needle,' for example. They get more of a self-critique out of it, and they get to actually see what they're doing right and where they can improve.

Pat Sim is quite the active mannequin, and even has pulse locations throughout her body, adding a whole new element to CPR training.

"We can do CPR training on Pat," Wanchisn said. "We call it Code Blue here at the hospital, because our training doesn't stop at CPR. We actually facilitate through the scenario to resuscitate the patient and get him or her back to life."

The laundry list of scenarios that could potentially be played out includes things such as tracheotomies, chest tubes, blood pressure screenings, checking for pulses, giving injections — including a special procedure during which IV access is gained through directly reaching the bone, which is optimal in severely dehydrated patients.

"We can mimic any of these scenarios, and then some," Wanchisn said.

Learning the ropes of Pat's complex programming is one of the challenges the staff in charge of the training sessions faces, but with some help from CHART, Wanchisn said they've already come a long way, and it just keeps getting better from here.

"We all kind of work together to make the most of this," she said. "CHART came here and trained us on how to operate the system, and they also offer us with ongoing support to help us refine and continue our enthusiasm and ability to run the simulator effectively.

Pat's role in the training process isn't limited to his programming, either, as sensors on the mannequin's body will let trainers and trainees know when something is going wrong — whether that's caused by something the trainee is doing or if it's just an added test from the trainer.

"If you press too hard on pulse check, it will sense that," Wanchisn said. "There are femoral pulses, and we can make the patient's heart race or slow down. He can even give us feedback."

At that point, Pat spoke up right on cue, saying, "I am very dizzy."

Wanchisn continued, "We have some canned text programmed into Pat, but we also have a microphone, so we can post someone in the hallway and they can be the voice of Pat Sim.

There's really just one limitation to the extent at which PAH can train its staff.

"We can do pretty much any simulation," Wanchisn said. "The only thing that our Pat Sim doesn't allow us to do is surgical procedures. There are special mannequins that you could do those procedures on.

“Under the skin of our mannequin, you'll find coils and springs. But with that said, there are procedures we can train. We can trach a patient and from there make it difficult to intubate. We can lock Pat's jaw, swell his tongue and make it so that once the tube goes down his throat, he's still not ventilating. So, really, we can do just about anything to make it a real scenario.

Adding a creative twist of her own, Wanchisn said she's even been able to add to the scenarios Pat offers.

"CHART gave us 13 scenarios, three of which are ER based, and the others are for inpatient units, including reactions to blood transfusions, cardiopulmonary arrest and diabetic emergencies. We can pick and choose what we want to do. I even purchased a small smoke machine to help us practice our emergency response in the case of a fire."

The best part about Pat and her training resources, Wanchisn said, is the fact that it is usable from start to finish, no matter the experience level.

"Beginning to end, Pat helps us cover the training gamut," she said. "It helps us leaps and bounds. We've already implemented it in new employee orientation. Josh Noerr, BSN, RN, ICU nurse, even said he'd have been 'delighted' to have the experience of hearing the lung and bowel sounds mimicked. On their first day here, trainees can hone in on those assessment skills to differentiate sounds on the mannequin."

Atop the list of benefits that Pat Sim offers, though, is the fact that his training allows for a safer, more patient-friendly PAH facility.

"It's great for the patients, too, because this is so realistic that it's not like it's someone's first time when we do procedures and tests," Wanchisn said. "One of the things we can do is, rather than have Josh (Noerr) just do an assessment, 
we can have him help a nurse practice a handoff. It helps us to hand off information effectively, and that's one huge asset of having the simulator here."

Another patient-comfortability benefit that Pat brings to the table is the ability to keep staff polished on procedures that they may not perform as often as they would need to in order to stay fresh.

"As a small, rural facility, we don't see some of these cardiac events or respirator events on a daily basis," Wanchisn said. "We don't see the same volume of those types of emergencies, and this helps us keep those skills polished so we're ready for anything."

Patti Dinsmore, MSN, RN, CCRN, director of critical care and outpatient, added that in her time training individuals, she has already seen one huge small-facility-specific asset Pat 

"Other hospitals are segregated," she said. "We have one medical/surgical unit, one ICU unit. There are no sub-specialties that people see over and over and over. To see it and do it until we're competent and efficient is just 

And while the old adage, "practice makes perfect," may not be necessarily true, Wanchisn said practice sure does add to the comfortability level of the trainees. And, when a trainee makes a mistake, it's less of a psychological hit for them, as well.

"A lot of nurses, if they feel like they made an error, it just crushes them," she said. "In this scenario, you can learn from your mistake, and you will never forget that experience. But it's not happening on a real patient, and you can practice until it's "made perfect," so to speak."

Noerr, BSN, RN, ICU nurse, echoed that sentiment: "Having a non-intimidating environment, where you can learn your skills, is just great," he said. "For nurses, IV starts are always a very scary thing. And now, we can practice those without sticking patients with needles. It's nice to have a space where you don't have to worry so much about making a mistake. It's just a nice, comfortable area, and it helps boost the confidence on staff, too."

Dinsmore also said that technology's come a long way, and the improved technology helps make sure that trainers have a broader impact on the patients' care.

"I have been involved in orienting nurses for quite a while, and I started out with a mannequin who did nothing," she said. "We used to use Post-It notes on the mannequin so the trainees had to look there for their assessments. I told CHART that to me, I can impact the care of so many more patients by being involved in this. I can help to provide the best care for every patient who comes through the door."

The team agreed that "Pat doesn't just make the training easier. Training is still training, and it can still be tough, but it makes the training more efficient and more effective.

"We are very excited to make our hospital a safer, better place for all who we serve," Wanchisn concluded.