PACE UNIVERSITY

COLLEGE OF HEALTH PROFESSIONS

SCENARIO: Home Hospice Care

Simulation Objectives: Initial Home Hospice Visit

At the end of this simulation sessions, the students will:
1. Complete a physical and functional assessment on the hospice patient in the home care
setting using appropriate evaluation tools as needed. (Katz Index in Activities of Daily
Living) (Psychomotor)
2. Perform a limited physical assessment appropriate for the dying patient (Psychomotor)
3. Communicate with patient and their caregivers in a comforting and supportive manner
maintaining patient dignity and integrity. (Psychomotor/Affective)
4. Manage Fentanyl patches (Psychomotor)
5. Communicate with the appropriate services for a patient who dies at home.
(Psychomotor)
6. Perform Post-Mortem Care. (Psychomotor)

Patient Overview:
Name: Julia Morales Age: 65
PCP: Ann Davis MD/
Laura Johnson NP MR# 123-456-78
Gender: M/F F DOB: 2/7/1954
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
Y: 7/16mbc; rev. 6/17 mbc, revised eab12/10/18, 7/31/18
 SET-UP State 1

Pre -Event Set Up Equipment / Props / Moulage

Pre Brief Room  Simulated Patient
 Room # L3  Simulated Partner
 Table; Chairs  Bed/Semi-fowlers
 Computer and TV with Simbridge Session  Home Chair
 Home table and lamp
Sim Room Tel # 30593 / Control Room Tel # 30598  Magazine/flowers
 Room # L1A  Oxygen in Use Sign posted
 Turn on manikin/ VS Monitor/Computer /  EHR Tutor ID band
Headwall Compressor  Nasal cannula oxygen set to portable tank at 2LPM
 Do Audio and Video Checks  Oxygen wrench
 Start Session in Simbridge; compare with  Hospice folder at bedside
student attendance record  Telephone with labeled number to call
 Identify Camera/Monitor feeds  Functional Assessment tools (Katz ADL tool)
 Confirm VGA Connections  Medication labeled Docusate sodium 100mg 1-2 capsules
 Open EHR Tutor: Course, Activity, Make orally daily as need for constipation
visible to students  Medication labeled Morphine Sulfate Controlled Release
 Set Initial VS and manikin state into 100mg orally every 6 hours as needed for pain.
computer  Wastebasket at foot of bed
 BP  Home Hospice bag containing: Ventriloscope, Blood pressure
 HR cuff, Portable O2 Sat monitor, Oral thermometer, gloves, tape,
 RR pen, pen light, bandages, scissors
 O2 Sat
 F
 Cardiac Rhythm:
 Breath Sounds:
 Bowel:

AFTER EACH SIM

 Turn off Sim Man; Computer; VS

Monitors; Med Cart Computer
 Restock CSR Cart

SBAR Handoff Report STATE 1

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

 Nurse Hand Off Report
Patient Info Name: Julia Morales MR# 123-456-78
Age: 65 Code Status: Full Code
DOB: 2/7/1954
Gender: Female
Language: English
Allergies No known drug allergies
Mental Status Alert and oriented
(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
Pain Assessment Morphine sulfate controlled release 100mg P.O. Q6H PRN pain
IV Access and Infusions None
Diet/Nutrition Diet as tolerated
(if applicable tube feeding)
Oxygenation O2 via NC @ 2lpm
Output Continent
(Foley, BM, Hemovac, JP,
Incontinent?)
Lab Values / Radiology N/A
Results
Focused Assessment Findings General Appearance: Awake, lying down, covered with a blanket
Respiratory: Nasal cannula O2 @ 2LPM on
Precautions (fall, isolation?) Fall Risk:
Recommendations 1. Do vital signs
2. Perform a focused respiratory assessment
3. Perform a focused pain assessment
4. Perform a functional assessment
5. Assess understanding of hospice care and explain purpose if needed

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

ORDERS STATE 1 BASIC CARE
Admit: Home Hospice
Diet: Diet as tolerated
Labs: N/A
Consult: Home Health Agency Visit
Treatments: Oxygen per nasal cannula at 2 liters per minute
IV Fluids: N/A
Medication: Docusate Sodium 100mg 1-2 capsules orally daily as needed for constipation; Morphine
Sulfate controlled release 100mg orally every 6 hours as needed for pain.

BP:
HR:
Pulse Strength:
RR:
O2 Sat:
Temp: F
Cardiac Rhythm:
Breath Sounds:
Bowel:
Skin:
Cap refill:
Pain:
Patient Response:

Expected Student Interventions STATE 1

 Assessment:
o Obtains vital signs
o Performs a focused respiratory assessment
o Perform a focused pain assessment
o Performs a functional assessment
o Assess understanding of hospice care
o Assess knowledge of advance directives/durable power of attorney

 Nursing Interventions:
o Evaluate oxygen therapy
o Position upright
o Ensure Oxygen tank is full
o Administers medications as needed following the Six Rights
o Initiate falls precautions and order a walker and bedside commode based on
functional assessment results
 Communication:
Y: 7/16mbc; rev. 6/17 mbc, revised eab12/10/18, 7/31/18
 o Explain purpose of visit
o Provides reassurance to patient and family
o Explain role of hospice
o Explain pain management
o Explain need for walker and bedside commode
o Review Advanced Directives

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