Meredith Rodriguez: Welcome everybody we'll get started here in just a few minutes, let everyone and I get in to the webinar we'll get started.
Meredith Rodriguez: Okay let's give another minute, or so I see.
Meredith Rodriguez: People are still coming on so just one minute on.
Meredith Rodriguez: The free to use the chat say hello.
Meredith Rodriguez: hi all let's go ahead and get started, because we have quite a bit of information, we want to get through today and let my former team article in but.
Meredith Rodriguez: let's go ahead and jump in So today we are talking about care team competencies to start off the New Year Happy New Year so we've made that traditional year mistake on our size already spent 22.
Meredith Rodriguez: But welcome if you go the next slide myself.
Meredith Rodriguez: Okay, so we'll start with our acknowledgement and disclaimer so emergency medical services for children, innovation and improvement Center is supported by the health resources and services administration.
Meredith Rodriguez: Of the US Department of Health and human services as part of the following Award for like 3 million was zero percent finance with non governmental sources.
Meredith Rodriguez: The contents are those are the authors and do not necessarily represent the official views of nor an endorsement, I heard say hhs or the US Government.
Meredith Rodriguez: More information, please visit krista.gov as usual is will be session will be recorded and posted to our website shortly, following our session today.
Meredith Rodriguez: and also our disclosure.
Meredith Rodriguez: Sit for all of our learning sessions to successfully obtain see any credit or in our CAP see credit.
Meredith Rodriguez: You must attend the live session, as well as complete the evaluation, which is set to go out to you guys as soon as the session ends today and, most importantly, the planners and presenters of this course, have no conflicts of interest to disclose next slide please.
Meredith Rodriguez: Quick agenda for the day i'm going to go through a quick overview of the collaborative what we're trying to achieve here what we're working through.
Meredith Rodriguez: and introduce our speakers for today, which will be Michelle meddling and Dr Kate remix.
Meredith Rodriguez: And they will talk you through sort of the overview and importance of really establishing.
Meredith Rodriguez: Care team competencies we'll go through some of the key drivers and change strategies and and how to implement that at your agency fire department or ED.
Meredith Rodriguez: i'm talking about how you would begin to do this walking through the process flow map and how you might begin to build a team.
Meredith Rodriguez: And then you'll hear from me again at the end on housekeeping items and quick reminders if you saw my email on from Monday night.
Meredith Rodriguez: we're beginning to think about phase two and so i'm going to go over kind of a phase two will look like towards the end of the session today as well, and then we will go into breakout sessions, where we have a fabulous lineup of guest speakers today and some group discussion.
Meredith Rodriguez: next one.
Meredith Rodriguez: Quick reminder if you see this icon you want to hear your thoughts we're going to try to use the Q amp a function, so you should on your screen see the chat box, but there's also a Q amp a button.
Meredith Rodriguez: And so I will be dropping these questions into the Q amp a and hopefully try to keep the conversation a little more organized based on questions but here's what works best for you next time.
Meredith Rodriguez: So um let's kind of take a step back here again and kind of a quick reminder of our goal and that really is our goal here is to.
Meredith Rodriguez: help you become a really effective pediatric emergency care coordinator, or a pediatric champion to really this this better understanding of systems design and quality improvement methodology.
Meredith Rodriguez: So if we click that in more straightforward terms it's really means we're not trying to just show you what this central elements and pediatric readiness are we're not.
Meredith Rodriguez: just trying to give you a checklist of the equipment and have you go down it and make sure you have all the equipment that we recommend for pediatrics but also.
Meredith Rodriguez: To really teach you how to go about this, so how to really think on a systems level of all the different.
Meredith Rodriguez: elements that can really interact to contribute to pediatric readiness, going beyond just the checklist and we do have a checklist and it's part of our resources, but this is really helping you to think more on on what are the processes that really drive improvement in this area.
Meredith Rodriguez: And so, with that understanding of you know, the way across this entire system will contribute to an improvement, we can then really use quality improvement methodology.
Meredith Rodriguez: And we've been sprinkling a little bit of the tools that we use in quality improvement throughout these past few sessions you'll get a little bit more today on measurement to really kind of help you understand how we approach this from a quality improvement standpoint.
Meredith Rodriguez: so next time.
Meredith Rodriguez: and through the cracks of that is this QA collaborative and so not only do we want to teach you a systems level design understanding and what color is, but our primary goal is to just really foster confidence in you and defining and embodying will have a peck.
Meredith Rodriguez: And then you know enrich that with ui improvements skills and provide you the framework of the tools like you said it, and then in phase two will really teach how to use it really had it, how to go through developing your project and working through it.
Meredith Rodriguez: but also what I think is important here is the collaborative aspect and that you are doing this, together with your peers, who are working on similar things and really building those relationships and building those networks.
Meredith Rodriguez: Including neck relationships with your mcc partnership managers and so i've mentioned several times before you each have one in your state and.
Meredith Rodriguez: can really help you in this journey of becoming more prepared for pediatric patients and they're a great resource and you're always welcome to email me, and I can help make those connections as well, and next time.
Meredith Rodriguez: So just kind of a quick snapshot of what this QA collaborative looks like in the graphical fun we're hearing phase one which is the top.
Meredith Rodriguez: we're really we've done this over and over, and I think our fifth focus area so with each focus area we go through the focus area.
Meredith Rodriguez: Understanding the importance understanding the processes behind what really drives up from a system standpoint work through what we call key drivers and change strategies and then.
Meredith Rodriguez: provide examples of what this looks like in real life in the breakout session so that's phase one.
Meredith Rodriguez: And then phase two is very really are going to do a Q I project, where you will develop a smart in your build a team and you're going to choose this change strategy and development implementation plan to really work through.
Meredith Rodriguez: That your organization and we can talk more about that at the end of the session today my next slide.
Meredith Rodriguez: So today's focus is really hasn't mentioned on the process and really, how do you go about improving not you know.
Meredith Rodriguez: What competencies, do you need to have and making a checklist and making sure that you have that that's important but it's also really.
Meredith Rodriguez: going about how you implement something like this within your organization, so the stories in a solutions that we.
Meredith Rodriguez: present here today are really just examples, so we really want you to remember that, as you think about what is best for your organization, so what opportunities for improvement, can you identify in your organization next time.
Meredith Rodriguez: So with that i'm going to introduce our two wonderful speakers today we're very fortunate to have Dr Kate remnick she is the Co director of the ic.
Meredith Rodriguez: she's also the medical director for San Marcos case county Ms system.
Meredith Rodriguez: As well as associate professor at don't Medical School at the University of Texas at Austin along with a think maybe 100 other things that Kate is involved in destination around pediatric readiness.
Meredith Rodriguez: And also Father proud to welcome back national magazine you guys have heard from Michelle a few times now.
Meredith Rodriguez: she's our co project manager for the ice disaster domain, as well as a nurse lead for the hospital domain she also is active in University Hospital renewal babies.
Meredith Rodriguez: Both within the hospital and and and they're sort of Community outreach as well, so with that i'm going to turn it over to Dr Eric and Michelle to take us through certain competencies.
Kate Remick: Thanks so much meredith and good afternoon good morning to everyone happy New Year we're excited to have you on the call today.
Kate Remick: Such as to get started as meredith already walked us through some of the components of phase one and how we approach this.
Kate Remick: really just beginning with a purpose statement and our goal here is really to make sure that.
Kate Remick: If you choose to focus on pediatric competencies, our goal is to really to develop a robust competency Program.
Kate Remick: And that's to ensure that our staff that we work with maintain skills, knowledge.
Kate Remick: To really safely and effectively manage critically ill and injured children so that's our goal we're going to talk about this from a high level at.
Kate Remick: A program level, but if you were to choose to focus on this and phase two the idea would be that you choose perhaps just one area to start.
Kate Remick: Before you're able to really grow out that program to be fully robust, so we understand that quality improvement takes time and effort and multiple cycles and.
Kate Remick: we're going to show you the the greater landscape, but the goal is always just to start with one first step, go to the next slide please.
Kate Remick: So, starting with background and importance, just to to frame this and I think many of you have heard about the initial.
Kate Remick: Institute of medicine report called the future of emergency care, this was a three part series.
Kate Remick: And now it's you know getting to be a little bit older it's about 15 years now behind us.
Kate Remick: But this was really the first report that cited some of the challenges that we were facing across the nation in terms of delivering high quality pediatric emergency care.
Kate Remick: And in that report, they they cited a number of shortcomings, but since then, there have been a number of additional publications that have really identified what some of these gaps are in much greater detail.
Kate Remick: We know that when it comes to initial Ms education that there's really a limited amount of training that's dedicated to specifically to pediatrics.
Kate Remick: In fact, in most Ms education programs pediatrics is limited to one single day with the advent of the new Ms education standards that just came out.
Kate Remick: Our hope is that we'll see that actually integrated throughout all training, but for the great majority of the Ms providers.
Kate Remick: They received really more or less one or two single days of training focused on pediatrics which doesn't really set a strong foundation of knowledge or understanding of the pediatric population.
Kate Remick: Following that we know that the majority of Ms agencies see fewer than eight children per month.
Kate Remick: And in fact in a study that came out of Boston most providers reported seeing fewer than three pediatric patients per month.
Kate Remick: So that means that initial foundational training limited and now ongoing exposure to the pediatric population is also limited where we know that children makeup you know five to 10% of all Ms transports.
Kate Remick: We also know that when it comes to Ms, of course, and because of this that there's just not a lot of opportunities to perform critical pediatric procedures.
Kate Remick: and studies that came out even 1015 years ago, which is likely not much different from now.
Kate Remick: There was one report out of California That said, it would take 20 years for every single paramedic in a 11 county area of California to perform bag mask ventilation on a pediatric patient just once.
Kate Remick: So these are the types of challenges that we're facing and why, having competencies in place and standardized for our system are so critically important.
Kate Remick: And then, when it comes to continuing education, we also know that at the state level there's truly variable requirements.
Kate Remick: For what that pediatric continuing education looks like and there are some states that, to date, still do not specifically call out pediatric continuing education as a requirement for ongoing licensing.
Kate Remick: You go to the next slide.
Kate Remick: On the ED side it's actually not necessarily much better, we know that there is some variability in initial and continuing education requirements for nurses and physicians.
Kate Remick: Certainly physicians that are trained in pediatrics and pediatric emergency medicine.
Kate Remick: or emergency medicine, where they get a significant amount of training and pediatrics they have a good amount of initial training.
Kate Remick: But the ongoing continuing education requirements may vary by specialty and by training program and the same is true for nurses, which is why so many additional programs have come out that are focused on opportunities to try to emphasize pediatric education.
Kate Remick: We know that about 70% of eds if you were them 15 pediatric patients per day, so this again is similar to what we see you know when we're talking about the the relative frequency.
Kate Remick: Of pediatric patients to adults in general pediatric patients make up about 20 to 25% of all ED visits.
Kate Remick: And we know that critical procedures are performed very infrequently on the pediatric population, in fact, there was a nice study that looked at about 1800.
Kate Remick: Emergency medicine physicians and over 50% of them performed a pediatric critical procedure in a single year.
Kate Remick: And only about 1% perform two or more procedures in a given year, so just not a lot of opportunity or exposure to working with critically ill and injured pediatric patients.
Kate Remick: Now it's going to be variable depending on what kind of emergency department you're working and if it's a children's hospital where that's your focus or general ED or perhaps even a freestanding ED.
Kate Remick: Where the frequency of performing critical pediatric procedures we know is even less upwards of close to 90% of physicians in those sites report performing a pediatric critical procedure.
Kate Remick: or zero in a given year.
Kate Remick: maintenance of board certification or nurse specialist certification can certainly help with maintaining cognitive knowledge really understanding what do we do in certain clinical conditions and situations.
Kate Remick: But, as you all, are very aware certification exams to not necessarily involve skills maintenance and so, if we really want to maintain her or skills and the focus on performing.
Kate Remick: These critical procedures, then there has to be a separate pediatric competency program that's developed within that institution, whether it be.
Kate Remick: Again, the emergency department, the global hospital or and or within the Ms agency, because of the next slide so as we've done in the past, I just want to kind of start with a case just to frame some of the challenges that we're facing on a day to day basis.
Kate Remick: In this this whole space, so this is a story of a toddler who was in the care of their older sibling who accidentally had left the front door open and in this moment the toddler wandered out of the front door of their home and into their street and was subsequently hit by car.
Kate Remick: The sibling witness the event grab their parents 911 was called and when the parents ran out to the street and saw that their child had been hit by a car.
Kate Remick: They panicked as you would expect, and at that moment, they didn't want to wait for MS to arrive, they were too worried too concerned about what was going to happen to their child.
Kate Remick: And about the potential impact of any time delays seeing how critically injured their child was.
Kate Remick: They quickly grabbed their child picked up their child and place them in the back of their car and drove as quickly as possible to the closest emergency department.
Kate Remick: And I just want to highlight that, for the lay person for a parent they don't understand the differences between an emergency department right, and this is really the crux of pediatric readiness, is that.
Kate Remick: When a parent sees a sign that says emergency or emergency department, the implication of that is that that site is able to handle any emergency.
Kate Remick: And so, these parents, rightly in their own mind transported this child directly to the closest ED which happened to be.
Kate Remick: A level for trauma Center that was only about five to 10 minutes away and because they drove this child in in private vehicle there was, of course, no notice given to that site.
Kate Remick: This particular trauma Center this level for trauma Center season average of less than 5000 pediatric patients per year and their overall volume is around 20 to 25,000 patients total.
Kate Remick: There is of course a level two trauma Center that they often rely upon, and so they don't usually expect to get this level of critically injured children.
Kate Remick: On a daily basis, but that level two trauma Center was about 15 minutes away from this site and much further for the family and that's not where they took their child.
Kate Remick: They do have a recessive station Bay, of course, this is a level two trauma Center but it's us pray my primarily for adults.
Kate Remick: They don't necessarily think of getting pediatric patients on a regular basis, and while they have a pediatric specific crush card or code court.
Kate Remick: It wasn't immediately available they didn't, for example, have the pediatric airway equipment automatically set up, they didn't have, for example, a PD tape or abrazo tape stretched out on the stretcher so that they could measure the immediate weight of a child.
Kate Remick: As we've already discussed, they also have limited exposure to pediatric recitations because that's the state of pediatric emergency care in this country.
Kate Remick: And when this child presents you can imagine what it would feel like to be on the receiving end of this here you are in a level four trauma Center and this child comes in and immediately on arrival with.
Kate Remick: being carried in the parents arms begin seizing and posturing.
Kate Remick: They quickly try to move the child into the resuscitation bay and get them hooked up to the monitor they get oxygen saturations on.
Kate Remick: And they see that this child's oxygen saturations are in the 70s and dropping they know the child needs to be sedated and intubated.
Kate Remick: There quickly trying to break into the pediatric cohort to find the appropriate size blood pressure coffin into trachea tubes they.
Kate Remick: begin to go towards their regular protocols for a standard sedation which is typically profile, which is what they use in the adult population.
Kate Remick: But for a child that's so young, and so small, the logistics of creating a profile drip for such a small or low weight child is.
Kate Remick: Is is not possible, and meanwhile, while all of this is going on the family is standing, of course, in the resuscitation Bay watching as the staff frantically try to find all of the equipment and get everything ready and out and available.
Kate Remick: Meanwhile, the Ms crew arrived on scene, and of course the child was no longer there, the first responders were there on scene and they advised as they had found out that the family had already left, and that was known by bystanders.
Kate Remick: At this point, the Ms crew decided that it's unlikely the child was taken to the Level two trauma Center the anticipated that this child would be transferred out and that support would likely be needed.
Kate Remick: And so, for that reason they went ahead and drove directly to the level for trauma Center that was closest to the family or closest to the family's home.
Kate Remick: At that point, they witness what was happening within the resuscitation Day, which was a challenge, by all accounts.
Kate Remick: And, fortunately, they brought in their PD bag, they were able to be and immediately helpful, they were able to pull out their own monitor pull out PD bag.
Kate Remick: equipment pull out their bras low tape assist actually with drug dosing because they had these medications immediately available.
Kate Remick: And the child was subsequently successfully intubated and prepped for transfer and the local pediatric trauma Center, which is about 45 minutes away was called and readily available to be able to support this.
Kate Remick: So, by all accounts, this was a really challenging case and I just want to pose a few questions to those of you that you know, are in the audience and listening to this.
Kate Remick: And starting really initially with the success of this, which is that, ultimately, this child ended up being sedated and.
Kate Remick: airway was you know appropriately obtained and stabilized they were able to treat the seizures clearly this child had obvious head injury.
Kate Remick: And they were able to manage that appropriately with support from the pediatric trauma Center.
Kate Remick: But the questions are what aspects of pediatric readiness contributed to the success in this scenario, so just really thinking about some of those items, and you know this is.
Kate Remick: Again, a really challenging case for any site, but I think the fact that you know the equipment was available, it was well organized.
Kate Remick: There was great collaboration from a multi disciplinary standpoint, and there are ways that you know this team really work together to make sure that the child received the best outcome.
Kate Remick: So feel free to type into the chat box, some of your thoughts.
Kate Remick: The second question that I would like to pose is what were some of the system level challenges that the team experienced, and again I want to emphasize that this is not about an individual, when we talk about quality improvement we're talking about.
Kate Remick: The impact that system readiness has on performance and outcomes, by all accounts, these providers both the ED providers and the Ms providers were very talented high functioning competent individuals that were working in these circumstances, because of their.
Kate Remick: Experience because of their knowledge, but the system is really where the challenges were, and that includes not really being set up for the pediatric population, not having ongoing.
Kate Remick: Exposure to these critically injured and ill children and lots of challenges that they face, just because the system wasn't set up to be able to serve this particular population to the best they could.
Kate Remick: If we go on to the next.
Kate Remick: question, and this is really the crux of why we're here today, which is how can this team prepare for similar events in the future.
Kate Remick: And if you think to your current circumstance, whether that be in your cms agency or in your emergency department.
Kate Remick: What would you do if this particular situation and presented itself to you and or your team, and how can you help to ensure that your system that your organization is prepared in the best way possible to address these types of events.
Kate Remick: Go the next slide please.
Kate Remick: So just to give some background on what we mean by competencies and.
Kate Remick: We alluded to this from the beginning but competencies are really not just about psycho motor skills it's often what people go to or they think about oh it's about.
Kate Remick: Maintaining skills, but it also has to do with maintaining knowledge and maintaining certain behavioral approaches, whether we're talking about, for example, team to.
Kate Remick: team communication or whether we're talking about family centered care, but there are really three aspects to any competency.
Kate Remick: And those are are presented here and there are certain approaches to how we maintain and ensure these competencies depending on which area they fall into go to the next slide.
Kate Remick: What we present here is maslow's phases of learning, which some of you may be familiar with, if I can draw your attention to the bottom right aspect of the screen, the way we start with learning any kind of.
Kate Remick: competency is is in this particular corner of the screen, which is that initially we may not be aware that a skill is even needed or that knowledge is even needed as we go through education we begin to become aware of the importance of our particular skill or.
Kate Remick: element of knowledge and it's only through regular practice that we work to develop that skill, but oftentimes we think of competencies as falling into that level three category there, which is where we might know how to do a skill, or how to.
Kate Remick: communicate effectively but oftentimes it requires thought or planning and so it's not really completely intuitive at that moment in time.
Kate Remick: And when we're trying to develop competency is what we're really trying to do is get to the stage for here, which is where it becomes almost.
Kate Remick: unconscious where it's almost a second nature and how we perform, for example, bag mask ventilation, or how we work with families, to ensure that their their needs are being met and heard.
Kate Remick: Go to the next slide please.
Kate Remick: So these are just some examples of competencies again, you might start with just one area of focus, based on what you know to be the needs within your system.
Kate Remick: So it could be that you would start with a psycho motor skill, maybe its challenges with bag mask ventilation in your system or challenges with medication administration.
Kate Remick: And these are some simple ones that you might be able to start with, if you're trying to develop a competency.
Kate Remick: Knowledge there's lots of ways to focus on that and the physician world and a nurse certification world's much of this is.
Kate Remick: Really deferred to ongoing maintenance of certification, but continuing education by understanding.
Kate Remick: Some of, for example, the signs and symptoms of respiratory distress or the effects of head trauma or different severity of head trauma.
Kate Remick: And then, when it comes to you know behavioral components of competencies, we might be thinking about as we've mentioned family centered care, but also things like practicing cultural humility nonverbal or de escalation techniques that might be used next slide.
Kate Remick: So just to reframe this in terms of what we've already covered over the course of this quality improvement collaborative we spent some time talking about.
Kate Remick: The importance of developing a policy or procedure protocol and that's really critical, because that is how we standardize our approach to care.
Kate Remick: it's through these policies, procedures and protocols that, for example, we might identify what are the equipment and supply requirements for institution or organization.
Kate Remick: The next step might be to further develop that process to ensure the availability of that equipment that is not expired that it's easy to locate etc, etc.
Kate Remick: And then moving into how do we really develop that robust equipments supply program is to make sure that all staff are oriented on it and know the location of it.
Kate Remick: But then, as we start to move into the world of competencies, we know that.
Kate Remick: day to day exposure to children is blow and so, in order to maintain or establish competencies, we may need to develop an education or competency Program.
Kate Remick: Where we're not only demonstrating how to use this equipment, but ensuring that there's regular exposure to be able to really develop those skills into that intuition or second nature.
Kate Remick: And then the last approach is to verify that so that we know that all of our stuff are maintaining that knowledge, skills behaviors and that way all of our patients in turn are receiving the same quality of care next slide.
Kate Remick: So, as you think about where you might start with developing a pediatric competency program there are examples that are in both the national kids ready ED checklist and then the national kids ready.
Kate Remick: Ms agency checklist both of those are on the msc innovation and improvements in our website and we can put that into.
Kate Remick: The link, once again, so that you can find those easily, but there are just some suggestions that you might start with there, maybe you already know where to start and that's fine too.
Kate Remick: But it's helpful to at least have an idea of where you think the gaps might be, and sometimes that's turning into your quality improvement or performance improvement program or specialist within your institution to help identify a good starting place.
Next line.
Kate Remick: So i'm just at you know as we think about quality improvement efforts developing a competency Program.
Kate Remick: We want to know that whatever work we do is actually leading to improvement, and we know you know edwards Deming denny and says, not all change leads to improvement right, and so we want to make sure that.
Kate Remick: measurement is a core component of the work that we decide to undertake and when we talk about creating an aim statement we talk about these smart aim so specific, measurable achievable.
Kate Remick: Relevant and time bound are time sensitive and so these are just examples of the type of aim statements that you might choose.
Kate Remick: When we talk about quality improvement, we also talk about structural process and outcome measures and each of these aim statements provides an example of what a structural process and outcome might be.
Kate Remick: So as a structural measure, it might be to simply develop a quarterly skills day for your clinical staff so that's a structural component, you have.
Kate Remick: A framework in place where those skills can be practiced and so by April 15 will have implemented a quarterly skills day for all clinical stuff great that's one great step.
Kate Remick: The next might be a process measure so by March 31 22 80% of our nursing staff will have demonstrated competency in medication administration.
Kate Remick: I was clearly has a number of layers it requires to get a you know, an evaluation of what that competency looks like that can be done in a number of different ways.
Kate Remick: But it involves a degree of measurement we're now we're saying of all the nurses staff that we have.
Kate Remick: 80% of them will have a demonstrated competency and medication administration and then the last is really more of an outcome measure, meaning that what is the impact on patients and families, so in this case the example is that by June 30.
Kate Remick: Over 80% of our agitated pediatric patients that come into the emergency department or into our agency.
Kate Remick: will have documented use of de escalation interventions prior to initiating chemical or physical restraints.
Kate Remick: And so you can see the potential impact that this would have on children, but until those staff have developed the competency in de escalation interventions.
Kate Remick: They won't be able to apply them effectively to our patient population again, these are just examples choosing one step is really the first way to start and i'm going to turn it over to Michelle Meg going to take it from here.
Michelle Moegling: Okay, everybody.
Michelle Moegling: we're going to talk about our key drivers and remember these are what directly impact our desired outcome or aim statement.
Michelle Moegling: You guys have seen this before, where we look at our aim our key drivers are secondary drivers and then our change strategies.
Michelle Moegling: Now, remember the specific change ideas to test are all going to come from your change strategies.
Michelle Moegling: And remember, this is just a review you're not going to be expected to implement all of these or even you may choose a different category, other than competencies, to look at making improvement, but all of your change strategies are going to be based on your aim statement.
Michelle Moegling: When we look at our first key driver diagram we're going to look at communication we're going to focus here on.
Michelle Moegling: How are you going to improve communication and this is going to be through leadership support staff buy in and patient and family engagement and you're only going to choose one change strategy to focus on.
Michelle Moegling: And when we look at it, a bigger at the bigger picture, there are many change strategies, you can look at we're going to review one example today and look at how do we advocate for the importance of including pediatric considerations in our existing training.
Michelle Moegling: And remember, just you're going to just choose one if you choose this topic.
Michelle Moegling: So when we talk about advocating, how do you go about this let's take a subcategory of pediatric patients and look at our trauma patients and immobilization.
Michelle Moegling: Either on scene or patients are presenting to your ad looking do you have the right equipment, do you stock pediatric and or infant hard collars are aspirin collars.
Michelle Moegling: How do you sighs a pediatric collar.
Michelle Moegling: Think about what are the differences between placing a hard collar on an adult patient versus a child.
Michelle Moegling: talk to your local This is where you can pull in your level one or Level two pediatric trauma Center that might be near you and get some outreach from them to assist in this.
Michelle Moegling: In the hospital remember to use or even it with Ms try and use one voice, where one person is just talking to that child.
Michelle Moegling: They keep them as calm as possible and allow the parent or guardian to stay with them, if possible, you know there's not times, where that can happen.
Michelle Moegling: A lot of times you keep them right at their head to head, so they can hear their parent if you haven't practice placing a C collar.
Michelle Moegling: How long do you think it would take you to put on a C collar on a child, think about if that child was an autistic child, how would you manage that So these are all things to think about as in just examples of things to consider.
Michelle Moegling: When we look at our second key driver, it is education.
Michelle Moegling: And how are you going to change or improve education you're going to look at your onboarding or training your competency reinforcement or you're just in time training.
Michelle Moegling: And again, we have lots of different change strategy ideas, and these are examples.
Michelle Moegling: But for this one we're going to look at how do we host a pediatric skills day with supplies and equipment being readily available.
Michelle Moegling: What well, you need you may need approval for additional time or time during your shift, you may need trainers to do, education and go over and review stuff with people.
Michelle Moegling: or trainers to sign people off as being competent with using certain equipment, you could also set up self directed stations where you're going through and practicing.
Michelle Moegling: And then doing a competency sign off separately, making sure you have supplies and equipment to use for the skills days.
Michelle Moegling: One of the best ideas is trying to keep your expired supplies, if you have an area to keep those and utilizing those during your skills days.
Michelle Moegling: You have to coordinate and set up times that all staff have availability to getting to these skills days, whether it's looking at how to use your browser to tape looking at your go bags your brows low card looking at that trauma patient or even doing your ios.
Michelle Moegling: or third driver we're going to talk about his policies and procedures.
Michelle Moegling: With through training or competency evaluation.
Michelle Moegling: yeah no not as many change strategies, but we still have more several.
Michelle Moegling: And we're going to focus today on creating or augmenting an existing policy to outline pediatric competencies that staff must maintain.
Michelle Moegling: If you have policies or procedures on equipment really look to see do you have those built into those policies.
Michelle Moegling: How often do they need to review them, are they required to have a competency whether it's at orientation and ongoing you don't have to necessarily give a time frame, you can use things like ongoing but then really being able to define that, for your specific unit.
Michelle Moegling: What are some topics for competencies that are likely to have a policy or guideline when you think about across whether you're a cms or an ad or hospital.
Michelle Moegling: You want to have family centered care guideline and how do you stay confident in that, looking at your easy I Oh, if you have that and how do you stay competent in that and placing those in children is a little bit different than adult.
Michelle Moegling: i'm in the ED maybe looking at sedation resuscitation for your IV pumps or other some of your other critical equipment for MS airway management in a mobilization.
Michelle Moegling: You want to ID your priorities of focus you don't need a competency on everything you want to look at what is your high risk, low frequency and emphasize on those and focus on that.
Michelle Moegling: Our next driver is our resources and tools with this, you want to know what resources and tools would be helpful for the care team competencies looking at training tools and equipment and then training expertise, maybe one or this may be different specialized equipment.
Michelle Moegling: Again, we have a lot of change strategies here, are you creating badge buddies contacting your Ms incorporating Sam for this example we're going to just look at creating a checklist for pediatric specific skills, whether it's advanced airway sedation or any other.
Michelle Moegling: opportunity.
Michelle Moegling: just looking at some examples of like for your psychiatric population having a checklist of knowing what to check in your room to make sure it's safe for them.
Michelle Moegling: Having documentation of who's check them who's looked over made sure they're changed into a gown and what tasks needed neck tasks need to be completed.
Michelle Moegling: When that patient comes in, or for even Ms looking do you have a tool, or a reference, if you have a child, with special health care needs.
Michelle Moegling: Because that is not a common population that's frequently seen how do you manage that pediatric trick if a patient has one do you have a reference that you can click quickly and easily pull.
Michelle Moegling: There may be things like badge cards or badge buddies for RSI or posters hanging in your resuscitation Bay to remind you code or an rp or pals what other things, can you think of, or what can have you utilized at your site.
Michelle Moegling: You put those ideas in the chat box.
Michelle Moegling: And then funding is always a concern when you're trying to create competencies and potentially pull stepping in to help with competencies or have staff come in extra to.
Michelle Moegling: Look at and do the competencies so looking at your staff resources and what budgetary implications does that have as far as for paying staff.
Michelle Moegling: So again, we have our change strategies that are just examples, you may have different examples that will work depending on your where you work and your scenarios.
Michelle Moegling: and looking at the assessing the availability of internal and regional resources resources that can help support your training free is always good to get resources.
Michelle Moegling: So there are several of these are all free resources that can be utilized for any site.
Michelle Moegling: There are simulations that are great opportunities to use for competencies, because you can usually get.
Michelle Moegling: Many different things signed off or checked off when you're doing a simulation it's just building this scenario to fit what you're trying to accomplish ASAP Sim has Ms and hospital sims.
Michelle Moegling: Then you can also look at your Low Level one or Level two pediatric trauma Center usually they're more than willing to come out and do outreach or come out and do pediatric trauma simulation.
Michelle Moegling: With hospitals and then our impacts impact hubs mark our backs going to talk a little bit more probably about this in the physician.
Michelle Moegling: Right breakout room looking to see impacts is a simulation where there are hubs and then they reach out to their Community spokes or hubs.
Michelle Moegling: And you can look and see if you have a hub in your area and maybe reach out to that hub, to see if they could do simulation with you and your site.
Michelle Moegling: and make that part of your competency training, as you do, that also gives you opportunities for improvement and identify be able to identify those.
Michelle Moegling: And then there's the EIC peaks which are the pediatric education and advocacy kits and those are on the msc improvement Center website currently we have one for status epilepticus suicide and then management of the agitated patient is coming very soon.
Michelle Moegling: and think about what other resources, you might have in your region or in your hospital or your Ms unit that you can utilize.
Michelle Moegling: Do you have Palace trainers or an rp instructors that can help with some of that you have people that are expert on certain pieces of equipment that can share the wealth with everybody else.
Michelle Moegling: And then, our last drivers always our hardest driver and that's changing culture.
Michelle Moegling: With change management and using your system hierarchies.
Michelle Moegling: Again, we have our change strategy examples.
Michelle Moegling: and looking to engage influencers champions, and the opponents in the training development process.
Michelle Moegling: Really, who are your influences influencers in your department or on your unit really talk to people and start with people that are easily.
Michelle Moegling: easy and early adapters because those are people you want to catch first and then remember time change does take time, if you get the early adopters and then work on the people that are nate may be naysayers are harder to get engaged in what you're doing and why it's important.
Michelle Moegling: That all the all end up being on board.
Michelle Moegling: One of the big things that when you talk about doing competencies or even simulation is really having that debrief after the competencies.
Michelle Moegling: These really we want this to be a really a learning environment that shouldn't be punitive or focusing out or one person that didn't do something right or didn't know something.
Michelle Moegling: So start with focusing after you're done is asking everybody how it, how does it, how did they feel, how do you think that when.
Michelle Moegling: Look, and asked what could have gone better.
Michelle Moegling: focus on patient care priorities or any latency safety concerns that you might have identified during it somebody may not have known Where are you that you had mcgill forceps or where they were.
Michelle Moegling: Think about how do we make that improvement and take as if one person doesn't know i'm sure there's more that don't know.
Michelle Moegling: So really focusing on making this a learning environment for everybody, and not just that one person didn't know and how could you not know that.
Michelle Moegling: But really engage your whole team on is there a better place, we could put piece of equipment is it something that needs to be gone over more frequently, think about those things, and how often you need to do your competencies.
Michelle Moegling: So how do we get, how do we begin with all this it's really assessing your baseline really going through our process flow map and looking at is there a defined list of pediatric confidence competencies and if there are our staff aware that pediatric competencies are there and.
Michelle Moegling: What they might be evaluated on is there a defined frequency for staff for reviews or competencies, is it just initial onboarding is it quarterly is it yearly what things have to be done.
Michelle Moegling: Is there a mechanism for placing in place for evaluation of your competencies, because you want your staff to give feedback on how the competency went they may have some ideas or opportunities for improvement.
Michelle Moegling: on making it better and making it more applicable for all staff and does your organization have resources and tools that are needed to train and evaluate staff on competencies.
Michelle Moegling: How many of these five processes are in place at your organization.
Michelle Moegling: i'm sure everybody doesn't have it.
Michelle Moegling: All of them, you may have some or you may have none and that's okay it's a place to start if you don't even have that defined list we're going to start there with that change strategy and how do you create that list of competencies.
Michelle Moegling: When you talk about building a team and how do you create that competency plan you want to look at who are the ideal TEAM members for creating a competency.
Michelle Moegling: You want to make sure it's multi disciplinary if you have educators or staff, if you are in a hospital and have nursing in paramedic staff, you want to include somebody from each discipline in creating that competency.
Michelle Moegling: can have different priorities one maybe met administration during a code one maybe have a priority of what equipment to use and how to use that.
Michelle Moegling: and discuss ideal TEAM members that should be involved and what improve what are you looking to improve.
Michelle Moegling: This can be a little more challenging when it comes to creating core competencies for quality and safety reasons it's essential that we continue to advocate for inclusion of pediatric specific competencies so we're comfortable taking care of that sick child when they do present.
Michelle Moegling: And having the expertise and the voice of the pediatric patient their families.
Michelle Moegling: Why do you believe, who do you believe would be ideal TEAM members, for your area or your squad to create those competencies.
Michelle Moegling: And then we went to look at our change strategies we really want to prioritize and look at how frequent do we think.
Michelle Moegling: A competency needs to be done and it may be different for different things, a piece of equipment that's very rarely used, but as high risk, you may want to do that more often.
Michelle Moegling: We always want to focus on perfect is the enemy of good.
Michelle Moegling: simulation can be used like I mentioned before, for many competencies and you can use multiple you can use low fidelity fidelity high fidelity or you could just do it, you can do it in person, or virtually.
Michelle Moegling: ASAP Sim has some virtual Sim simulation that you can do and walk through how to use stuff and what to do with a certain type of patient percents.
Michelle Moegling: competency should be based on the scope of practice whether you're a physician that paramedic or a nurse.
Michelle Moegling: And really assuring that we have compliance with regulation if our policy say that we do a competency every so often.
Michelle Moegling: Joint Commission is going to be looking at that if you're an accredited joint Commission facility, the goal with competencies is really to improve quality improve confidence and staff and to reduce errors.
Michelle Moegling: And these are just a couple of examples of some competency paper forms, I know a lot of stuff is gone goes more electronic now, but these are just some examples of a Ms pediatric io infusion and then a competency for some equipment in a needy.
Michelle Moegling: How do you assess for improvement in your competencies that can be done through a variety of ways, you can test theoretical knowledge by doing a test just a paper or a pen test or a survey monkey test or quiz really focusing on pre and post assessments.
Michelle Moegling: So if you've done a theoretical knowledge test after you've done the education for that men do a post test as well, to see what was the improvement.
Michelle Moegling: You want to get feedback from your team to see did this work for them, did they learn from it are there other ways that it can be taught or different ways.
Michelle Moegling: You can go through simulation and looking at real situations that are presented to your ED you can look at chart audits, whether that be triage.
Michelle Moegling: Regular documentation or your pain assessments and then hands on with equipment, how to set it up and how to run it.
Michelle Moegling: Some resources for competencies can be the peace ready checklist both the ED and Ms checklists on the EIC we talked about the peaks.
Michelle Moegling: The npc class, which is a classes through na etc, which is through na emt and we have pap PD steps pals and rp ASAP sandbox and Those are just some examples of educational programs some of those are online and some of those are paid classes or resources.
Michelle Moegling: And we talk about measurement in our care team competencies, we have to really remember measurement is key to providing quality and improvement, and it is essential.
Michelle Moegling: Having pre and post measurement so once you identify your aim statement and what you're going to look at really get a pre assessment of an or measurement of what you're going to measure so, then you can show improvement as you make these changes and design your key driver diagrams.
Michelle Moegling: there's going to be a change in performance over time looking at your patient error trends, over time, better performance will be reflected and lower error rates.
Michelle Moegling: And then your patient satisfaction scores looking to see if those are going up, make sure you're always referring back to your aim statement.
Michelle Moegling: it's okay to not meet your goal and continue working to get to that goal, which may require some adjusting of your key drivers or your change strategies.
Michelle Moegling: And then, in summary, identify a single change strategy to implement it doesn't have to be from this module it could be from any of the modules that we're.
Michelle Moegling: Covering in this workshop evaluate the impact over time things that have infrequent exposure, especially critically ill and injured children.
Michelle Moegling: Remember that the skills wane over time so doing that more than once a year, integration of pediatric specific competencies into your policies and practice to help sustain your pediatric capabilities.
Michelle Moegling: And remembering all emergency care organizations should identify pediatric competencies for inclusion, whether it's skills, knowledge and behaviors.
Michelle Moegling: If you have questions you can put those in the chat box and we will try and get those.
Michelle Moegling: And i'm going to turn it over to meredith.
Meredith Rodriguez: Thanks thanks katie you guys did a great job today awesome presentation.
Meredith Rodriguez: As Michelle said go ahead and put some questions in the chat there's actually been a pretty great conversation going over there around yeah the impact group and sin.
Meredith Rodriguez: And we'll talk about that because marks going to speak in our physician breakout room and also some other.
Meredith Rodriguez: fabulous speakers to do those I don't you forget about them, so what you should have completed by now is all of the focus areas one through four, including the environmental scan worksheet which to complete online to red CAP, as well as the session evaluations for each of these sessions.
Meredith Rodriguez: This month carotene competencies, so the focus area guide and environmental scan worksheet link should have gone out to this morning I apologize for the delay on that.
Meredith Rodriguez: And then, as I mentioned at the top of the hour, the session evaluation should will go out to you in about an hour as soon as the breakout sessions, and so you can complete that.
Meredith Rodriguez: And then kind of looking forward rehab a coaching session in two weeks on January 20.
Meredith Rodriguez: These are optional there's no structure to these hours they're really to just bring your questions and we can really talk about how to use quality improvement to drive improvement.
Meredith Rodriguez: And then very, very we'll talk about communication collaboration across systems of care, followed by another coaching session quick reminders on continuing education credit CAP see will be awarded after the final learning session on march 3.
Meredith Rodriguez: Eight hours of cassie credits money is awarded on a.
Meredith Rodriguez: rolling basis is an entertainment month here, so you should have all of your certificates.
Meredith Rodriguez: 123 I think for should be coming out very soon i'll just basically so on that and then MLC part for you must complete phase two of the collaborative which we'll talk about in a little bit more depth if you've got an exciting shall.
Meredith Rodriguez: We.
Meredith Rodriguez: Okay, so um phase two is going to roll out on march 17 so phase one of the collaborative officially ends march 3 that's our final learning session.
Meredith Rodriguez: And you will have the option to continue with phase two it's not a requirement.
Meredith Rodriguez: And really the the idea around phase two is for you all to take over so they'll you'll hear a lot less from us we're really going to serve in a coaching role.
Meredith Rodriguez: and guide you through how to develop and implement a qr code project at your organization.
Meredith Rodriguez: So, to make our lives, a little simpler we're going to limit it from the seven areas of focus down to four, so you can choose to develop a project within any of the four following areas.
Meredith Rodriguez: Are you msc program i'm going to talk to that i'm going to talk about this to you guys in breakout session, but for all of our more clinical roles, these are your four topic areas which is really focused on maybe developing early advocating for the petrol.
Meredith Rodriguez: Security securing or doing something additional around equipment supplies medications today's topic here are some competencies or developing a policy or procedure or care pathway or algorithm or something within that realm so.
Meredith Rodriguez: The CAP see credit and cne will no longer be available for face to hurry can use this as a clinical ladder project and we'd be happy to supply a certificate of completion and whatever else you might need.
Meredith Rodriguez: to really work on this as part of a kind of a ladder project, as I mentioned on the last slide 25 and MLC maintenance of certification part four points will be available for physicians.
Meredith Rodriguez: You must do at least three pdsa cycles to have that awarded, and so I will send out and watch it, so I want you to start thinking about if this is right for you, I want you to talk to your leadership.
Meredith Rodriguez: and others within your organization to see if this is something that maybe you could have some support in and engaging with.
Meredith Rodriguez: And then on January 21 I will send the survey out which really kind of confirms your participation for phase two.
Meredith Rodriguez: And we really are going to limit this to those of you who are actively participating in a project so unfortunately we're not going to allow anyone who's not.
Meredith Rodriguez: developing their own project to kind of come along for the ride, because we really want engaged in that conversation, and everyone collaborating.
Meredith Rodriguez: around what they're working on and sharing what they're working on so as part of the session is going throughout the spring these days in blue, you will have a template side, maybe just one.
Meredith Rodriguez: Around the topic of the day, so even be, what is your smarting or who's on your team, or what change strategy have you selected or what are your barriers, and you will.
Meredith Rodriguez: We will ask first asked for volunteers to kind of share and it won't be this large of a group will be in their smaller topic area breakout rooms and, if not we're going to just merely randomly call on people so.
Meredith Rodriguez: expect to come prepared to all of the meetings during phase two is something to share.
Meredith Rodriguez: If you should have my email display but i'll drop it in the chat as well, if you have more questions around what face to look like and happy to answer them.
Meredith Rodriguez: And with that it's about 10 good our breakout rooms so Michelle if you could go to our next side well.
Meredith Rodriguez: You guys gets messed up but anyways we have some fabulous speakers for today so i'm going to drop the links to all the breakout rooms in the chat.
Meredith Rodriguez: i'm the keynote or teeth, he is a paramedic and educator with mental health network in New York.
Meredith Rodriguez: In our pre hospital breakout room, we have dusky Lynn has also a fabulous educator out of charlottesville who is going to speak to our nurse and other health care provider breakout room.
Meredith Rodriguez: As you saw in the chat Dr mark our buck is going to talk a little bit about the impacts group and Sim.
Meredith Rodriguez: And then, our MSP programs, we have to presenting on integrating the petrol and the pediatric medical recognition programs both Danny Lee and see ambience.
Meredith Rodriguez: As I mentioned in the chat you don't you're not locked into any breakout room, if you want to go here talking about talking about sin you're welcome to go to that group but don't forget our other fabulous speakers today.
Meredith Rodriguez: So with that just kind of let me drop these in the chat and then give us all a few minutes to switch rooms and we will see you all in these breakout rooms.
Meredith Rodriguez: So what you'll have to do is leave this webinar and go to some of these one of these breakout links, you should have my calendar invite I just put them in the chat.
Meredith Rodriguez: And you should have an email that I sent on Monday, but please let me know if you if you don't have the link and I can get it to you.
Meredith Rodriguez: So thanks everyone appreciate it.
Michelle Moegling: Thank you Miranda.
Michelle Moegling: Good go to your display settings St and flip it.
Michelle Moegling: yep just do yep.
Michelle Moegling: perfect.
Michelle Moegling: Thank you dusty.
Michelle Moegling: um did you guys do any pre assessments, when you started this project on.
Michelle Moegling: comfort of staff with the bag valve mask.
Michelle Moegling: Okay.
Michelle Moegling: yeah.
Michelle Moegling: No that's great I think that's just the one thing that really.
Michelle Moegling: As you do your quality improvement, if you want to, if you want to look at something similar to this is really getting.
Michelle Moegling: Your pre data, so you can really as you want to present this to whether it's your leadership or your team.
Michelle Moegling: Then you can actually show your improvement that you've done and I think that's always beneficial for staff to see that that improvement, and you can it doesn't have to be like you said, if you just like get a show of hands, how many people.
Michelle Moegling: Do you think you can get blow by with.
Michelle Moegling: It doesn't have to be anything technical that's just that's data right there.
Michelle Moegling: Because I still get amazed at the number of people that don't know that you can't give blow by with a bag of mass.
Michelle Moegling: anybody else have questions or thoughts for dusty.
Michelle Moegling: or where do you see at your site, the need, what kind of what type of competencies, do you guys do or see a need for if you don't have them or, if you do have them, but still seem like you think it's something that should be worked on.
Michelle Moegling: And if you work at a certain time of organization you guys are quiet today it's a new year because they're usually chatty cathy's.
Michelle Moegling: How often do you guys, as we talk about competencies in general, how often do you guys do competencies in your own areas or units dusty How often do you guys, do you know.
Michelle Moegling: Either one.
Michelle Moegling: their hands on.
Michelle Moegling: How about other people how often do you guys do those at your facility, whether you want to you can unmute yourself and talk, or you can put it in the chat.
Michelle Moegling: yeah.
Michelle Moegling: great idea.
Michelle Moegling: struggling with co bed to either do sims or your motto or do competencies at all um some of the things that are ED educators, have done is they've actually created some videos.
Michelle Moegling: For like our code pink and our deliveries and that way staff can go back to that video pull it up and look at it.
Michelle Moegling: Also, creating some just in time learning so if you have equipment, maybe, creating a video or a how to on your level one fluid warmer that's used very infrequently.
Michelle Moegling: that staff can, if they have downtime on the shift, they can pull that up and maybe track it or do things like thinking outside the box.
Michelle Moegling: If you haven't looked at a separate sandbox they actually have their sims setup that you can do them virtually and we've done that, with several of our Community hospitals.
Michelle Moegling: So if you're the pack or somebody like that it's it's really walking through it's not hands on but it's really it really focuses on communication.
Michelle Moegling: It makes people really think about communication and a code because you're talking through everything you're doing rather than doing hand but other than touching and grabbing and moving stuff.
Michelle Moegling: and talking about like Where would you find this and what would you be doing next so those have been very beneficial for some of the sites that we've done that.
Michelle Moegling: And they can be done, like hybrid where there's one person in the room, if you're the educator the person running it in the people at home can tell you hey where do you find this.
Michelle Moegling: going through is things like that.
Michelle Moegling: And it up, they only take like a half hour at the most so they're short so usually getting people to call in or zoom in from home hasn't been an issue.
Michelle Moegling: Because it doesn't take you overtime usually.
Michelle Moegling: Know right now, people are so burnout though I know it's hard, but just thinking out of the box of how can we do things and still keep everybody confident and comfortable caring for pediatric patients.
Michelle Moegling: yeah technology's come a long way and I think videos and even like connecting on the qr codes on different things.
Michelle Moegling: yeah.
Michelle Moegling: Anybody not have.
Michelle Moegling: Any.
Michelle Moegling: Good.
Michelle Moegling: Does anybody not have competencies or pediatric competencies.
Michelle Moegling: it's okay.
Michelle Moegling: No okay.
Okay.
Michelle Moegling: Okay.
Michelle Moegling: Do you think the main room presentation was helpful and looking at what the different aspects of competencies.
Okay.
Michelle Moegling: yeah i'm looking at the piece of pizza ready checklist it'll give you just a it'll give you a few ideas as well and or if you're a Ms do there's some of their as well listed.
Michelle Moegling: And a lot of that we didn't want to list what competencies, you should or shouldn't have because really a lot of that's based on your hospital.
Michelle Moegling: What does it require what does your regulatory bodies require you and it varies on like your volumes of kids to and what different things that you have.
Michelle Moegling: If you're a small community hospital, you may not have an informer or anything like that, but how do you manage that baby when that newborn delivery comes in, from the Community.
Michelle Moegling: Because, at least in my area they always present to the Community, do they deliver it home and show up in the Community ED.
Michelle Moegling: it's very challenging to capture and how do you capture them through all of that stuff because their orientation is usually very short on travelers like a couple days.
Michelle Moegling: yeah.
Michelle Moegling: it's picking picking your battles, or where to choose of like what is your high risk equipment that you really need to cover with them.
Michelle Moegling: and making sure that at least that is covered your ABC.
Michelle Moegling: yeah.
Michelle Moegling: yeah because the boards of nursing are different state to state what they require so really I think you're right, as we have more and more travelers getting the boards to come together is really going to be key to standardize at least some things that are required to travel.
Michelle Moegling: or.
Michelle Moegling: yeah.
Michelle Moegling: Somebody has an idea of like pat creating packets.
Michelle Moegling: Has anybody ever done any measurement with competencies your thought about how they would do that.
Michelle Moegling: or even thinking, if this is one of your areas like what type of aim statement would you create.
Michelle Moegling: You guys feel comfortable.
Michelle Moegling: You guys feel comfortable creating a name statement.
Michelle Moegling: it's Okay, to be honest.
Michelle Moegling: And I think this is like, if you are one of those in you're just not comfortable it's talking with your manager and saying hey rookie.
Michelle Moegling: Being able to clearly let them know what you see as a concern and what your idea is to improve it and hopefully they will help work with you.
Michelle Moegling: and teach you and guide you along with that, and if you are interested remember our phase two is really going to be doing that you have to do the work, but we will help you do that work as well.
Michelle Moegling: But you have to start by trying to create that aim statement yourself and it doesn't matter if it's right or wrong there's no real wrong if it's not like written the appropriate way, we can guide you into how to do that this is all about learning.
Michelle Moegling: and making improvements.
Michelle Moegling: So if you are interested, remember, please sign up for phase two if you really want to create a process improvement project at your facility.
Michelle Moegling: it's a great way to do it is getting having other people around you helping you do.
Michelle Moegling: What you're going to do, and also then potentially going up the clinical ladder.
Michelle Moegling: yeah.
Michelle Moegling: yeah and it's looking breaking down like which category, do you want to focus on, and then, what exactly do you want to improve and really going down to like just very detailed.
Michelle Moegling: Of what you want to improve and how are you going to be able to show that improvement and thinking about that at your work, because it differs that organizations, how you will show improvement and what your plans and your thinking is.
Michelle Moegling: yeah.
Michelle Moegling: Yes, I agree.
Michelle Moegling: Because i'm sure.
Michelle Moegling: i'm sure many of us feel that way.
Michelle Moegling: And remember utilizing the free resources that we shared today the ASAP Sam looking at impacts, if you don't have simulation available to you looking to see if there's it has a map of all the hubs.
Michelle Moegling: and reaching out to that hub site and saying hey are you talking to your manager first or, if you are the manager.
Michelle Moegling: Saying our site, would like to be part of this, because what they do is they come out and they'll do a full day of like they'll do two sessions with them.
Michelle Moegling: And they'll go through like three different scenarios will do one in the morning and then wanted another group in the afternoon.
Michelle Moegling: And they will give you a breakout of where you have opportunities for improvement and help thing work with you to create that age statement and get through work through process improvement.
Michelle Moegling: And then hopefully come back again every so often and do codes with do simulation like codes we've done everything from my foreign bodies to anaphylaxis to newborn resuscitation to sepsis.
Michelle Moegling: And utilizing those resources if they're available and out there, near you.
Michelle Moegling: Okay, everybody what time is it does anybody else have any questions or thoughts.
Michelle Moegling: or anything else Lisa you think.
Michelle Moegling: Let people get get get 15 minutes of their time back for some coffee or relaxation.
Michelle Moegling: Thank you guys very much for taking the time to join this collaborative and being part of this group.
Michelle Moegling: Yes, thank you so much dusty that was wonderful.
Michelle Moegling: Today Thursday yeah i'm working from home tomorrow so i'll see you Sunday at the airport.
Michelle Moegling: down, I had the United APP on my phone, so I just i've ended up ended my code in there and i'll pop up.
Michelle Moegling: shop.
Michelle Moegling: For the boarding passes didn't yet, but my flight information did.
Michelle Moegling: You were flying united.
Michelle Moegling: yeah.
Michelle Moegling: Okay okay I.
Michelle Moegling: back.