PACE UNIVERSITY

COLLEGE OF HEALTH PROFESSIONS

SCENARIO: Home Hospice Care

Simulation Objectives: Focus on Pain Management

At the end of this simulation sessions, the students will:
1. Perform a limited physical assessment appropriate or the patient in pain (Psychomotor)
2. Communicate with the patient and their caregivers in a comforting and supportive
manner maintaining patient dignity and integrity. (Psychomotor/Affective)
3. Manage Fentanyl patches: check placement, date, and time (Psychomotor)
4. Medicate for breakthrough pain (Psychomotor)
5. Educate patient and family on pain management options (Cognitive/Affective)

Patient Overview:
Name: Julia Morales Age: 65
PCP: Ann Davis MD/
Laura Johnson NP MR# 123-456-78
Gender: M/F F DOB: 02/07/1954
Setting: Home Time: 8AM or Sim Time

Setting Overview: Home

STAFFING NEEDS / ROLES

Simulation Tech Computer Operator - Simbridge / Manikin/ Voice of Patient;

Nurse Intern Overhead speaker; EHR Tutor; Phone Operator

Nurse Intern / MBC Lab; Pharmacy; CSR; IT etc

Faculty PCP; Observer of student performance

Students Four active participant with responsibilities focusing on roles:

Team leader/ delegation, physical assessment, documentation, medication administration
Observer/Annotator

SET-UP State 2
Pre -Event Set Up Equipment / Props / Moulage
Pre Brief Room  Simulated Patient
 Room # L3  Fentanyl 50mcg/hr patch on patient
Y: 7/16mbc; rev. 6/17 mbc, revised eab12/10/18, 7/31/18
  Table; Chairs  Scopolamine transdermal patch 1.5mg behind patient’s left ear
 Computer and TV with Simbridge Session  Simulated Partner
 Bed / Semi-fowlers’ position
Sim Room Tel # 30593 / Control Room Tel # 30598  Home Chair
 Room # L1A  Home table/lamp
 Magazine/flowers
 Turn on manikin/ VS Monitor/Computer /
 Oxygen in Use sign posted
Headwall Compressor
 EHR Tutor ID band
 Do Audio and Video Checks  Nasal cannula oxygen set to portable tank at 2LPM
 Start Session in Simbridge; compare with  Oxygen Wrench
student attendance record  Walker at the bedside
 Identify Camera/Monitor feeds  Bedside Commode
 Confirm VGA Connections  Box of tissues
 Open EHR Tutor: Course, Activity, Make  Copy of Advance Directive (MOLST form)
 Home Hospice folder
visible to students
 Medication labeled Docusate sodium 100mg 1-2 capsules
 Set Initial VS and manikin state into orally daily as needed for constipation
computer  Medication labeled Morphine sulfate liquid drops 5-20mg
 BP 106/70 every 2-4 hours as needed for pain, not to exceed 100mg in 24
 HR 97 hours.
 RR 22  Medication labled Fentanyl transdermal patch 50mcg/hr every
72 hrs.
 O2 Sat 97% on room air
 Medication labeled Scopolamine transdermal patch 1.5mg
 98.7 F every 72 hrs.
 Cardiac Rhythm: Sinus tachycardia  Wastebasket at foot of bed
 Breath Sounds: Clear in all lung fields  Home Hospice bag containing: Ventriloscope, Blood pressure
 Bowel: hypoactive cuff, Portable O2 Sat monitor, Oral thermometer, gloves, tape,
pen, pen light, bandages, scissors

AFTER EACH SIM

 Turn off Sim Man; Computer; VS

Monitors; Med Cart Computer
 Restock CSR Cart

SBAR Handoff Report STATE 2

Nurse Hand Off Report
Patient Info Name: Julia Morales MR# 123-456-78
Age: 79 Code Status: DNR
DOB: 02/07/1954
Gender: Male
Y: 7/16mbc; rev. 6/17 mbc, revised eab12/10/18, 7/31/18
 Language: English
Allergies No known drug allergies
Mental Status A&O x3 Restless/Pain
(AO X3 X2 X1, Confused?
Dementia? Non-verbal?)
Chief Medical Complaint Adenocarcinoma of the lung Stage 4
(diagnosis)
Medical History Adenocarcinoma of the lung diagnosed 4 years ago treated with radiation
and chemotherapy
Hysterectomy age 44
Social History: Retired from work in local nursery/garden center. Lives
with partner Lucy. Son Neil age 42, lives 20 miles away. Private
insurance.
Latest Vital Signs BP 96/66 HR 102, RR 24 Labored, Temp 97.9 F
Pain Assessment Pain 6/10, Fentanyl transdermal patch 50mcg/hr in place
IV Access and Infusions None

Diet/Nutrition Diet as tolerated

(if applicable tube feeding) Scopolamine 1.5mg patch in place behind left ear for nausea
Oxygenation O2 via NC @ 2LPM
Output Incontinent
(Foley, BM, Hemovac, JP,
Incontinent?)
Lab Values / Radiology N/A
Results
Focused Assessment Findings General Appearance: Uncomfortable, lying in bed, restless.
Cardiovascular: HR 102
Respiratory: RR24/labored. O2 via NC @2LPM on
Skin: Intact
Precautions (fall, isolation?) Fall Risk: high-risk; Impaired skin integrity: high-risk
Recommendations 1. Perform limited physical assessment for the patient in pain
2. Perform a focused pain assessment
3. Check Fentanyl patch for placement, date/time of expiration
4. Educate patient and family on pain management options.

Y: 7/16mbc; rev. 6/17 mbc, revised eab12/10/18, 7/31/18

ORDERS STATE 2 BASIC CARE
Admit: Home Hospice
Code Status: Do Not Resuscitate (DNR)
Diet: Diet as tolerated
Labs: None
Consult: Home Health Agency Visit
Treatments: Oxygen per nasal cannula at 2 liters per minute
IV Fluids: None
Medication: Morphine sulfate liquid drops 10-20mg as needed every 204 hours for pain, not to exceed
100mg in 24 hours; Docusate Sodium 100mg 1-2 capsules orally daily as needed for constipation;
Fentanyl transdermal patch 50mcg/hr every 72 hours; Scopolamine transdermal patch 1.5mg every 72
hours
Other: Notify Dr. Davis immediately upon patient’s death.
BP:
HR:
Pulse Strength:
RR:
O2 Sat:
Temp:
Cardiac Rhythm:
Breath Sounds:
Bowel:
Skin:
Cap refill:
Pain:
Patient Response:

Expected Student Interventions STATE 2

 Assessment:
o Perform limited physical assessment for the patient in pain
o Perform a focused pain assessment
o Check Fentanyl patch for date/time of expiration
o Check Scopolamine patch for date/time
 Nursing Interventions:
o Turn and Position every 2 hours
o Administers pain medications as needed following the Six Rights
o Confirm advance directive is present and signed
 Communication:
o Provide education regarding pain medication
o Provides emotional support to family member
o Communicates with MD regarding pain management as needed
Y: 7/16mbc; rev. 6/17 mbc, revised eab12/10/18, 7/31/18