Exit this survey KidSIM Simulation Activity 1. KidSIM Simulation Session Activity Report Question Title * 1. Simulation Session Date Please enter Simulation Session Date Question Title * 2. Please list number of participants for each discipline (if number is zero please leave blank) Staff MD Fellow Resident Medical Student Nurse Practitioner RN LPN Health Care Aide Nursing Student Paramedic/EMT EMS Student RT RT Student Family Member Other Question Title * 3. The zone the session took place North Edmonton Central Calgary South Other Other (please specify) Question Title * 4. The Organization/Institution the primary learners belong to Alberta Health Services Covenant Health Mount Royal University SAIT University of Calgary Bow Valley College Other Question Title * 5. Site ATSSL Airdrie Community Health Centre Alberta Children's Hospital Calgary Remand Centre Foothills Medical Centre Mount Royal University Okotoks Health & Wellness Centre Peter Lougheed Centre Rockyview General Hospital SAIT Sim Lab South Health Campus Southport Tower Tom Baker Cancer Centre University of Calgary Mobile/other Mobile/Other (please specify) Question Title * 6. Program/Department Anesthesia Cancer Care/Hematology Course/Conference Emergency Emergency Medical Services Family Centered Care Hospital Pediatrics ICU Internal Medicine Mental Health NICU Outpatients PACU/OR Palliative Care Pediatric Home Care PICU Rehabilitation Respiratory Trauma Transport Surgical Services Other Other (please specify) Question Title * 7. Name of session - as per booking (ie. UIPE, PALS, MEPA, etc) Anesthesia Academic Half Day ASSET Foundations ASSET Advanced ASSET Co-Debriefing ASSET Peer Coaching ASSET Refresher BLS CPR Day Surgery ECLS/ECMO ER Adult Course ER Attendings ER Clerks ER Ed Day ER Fellows ER Fellows Academic Half Day ER Junior Residents ER Nursing Orientation ER Senior Residents Emergency ENPC FCC GNO Hospitalist ICU Ed Day ICU JIT ICU Mock Codes ICU Nursing Orientation ICU Resident Teaching Inpatient JIT MEPA Mobile Education NICU JIT NRP OR Outpatient Education PACU PALS PEARS PEACH Pediatric Academic Half Day Pediatric Care Update Pediatric Nursing Update PRISE Research RT Education Rotary Flames House STEP TNCC TPAC Airway Course Transport Trauma Trauma Orientation Surgical Services Sim UIPE Unit 1 Ed Day Unit 2 Ed Day Unit 3 Ed Day Unit 4 Ed Day Other Other (please specify) Question Title * 8. What type of session took place? In-Situ (Within clinical practice area) Simulation Lab Mobile Question Title * 9. Length of sessionPlease enter length in hours. (round up to nearest 30 mins) Hours Question Title * 10. Number of scenarios used for entire session (all labs) Question Title * 11. Number of labs running concurrently (at same time) Question Title * 12. What were the topics covered? (ie. sepsis, trauma, asthma, etc) Question Title * 13. Were any of the following standardized elements included in the scenario?Check all that apply. N/A 2 client identifiers Critical language tools (e.g CUS) Dangerous abbreviations Emergency management codes (ie. Code Blue) Fall prevention Family member supporting the patient (spiritual/ cultural practices, self care, etc) Hand Hygiene Handover Hazard identification/ RLS IV line verification Medication safety Narcotic Safety Safe surgical checklist Structured communication (SBAR, NOD) The process of disclosure of harm Other (please specify) Question Title * 14. Was the simulation session inter-professional? Yes No Question Title * 15. Name of Facilitator(s): 1 2 3 4 5 6 7 8 9 10 Question Title * 16. Simulators Used? Check all that apply. Adult Pediatric Premature Infant Maternity Infant None Other (please specify) Question Title * 17. Were there any issues with mannequins or other equipment? No Yes please describe the issue and if it had any impact on training Question Title * 18. Were any hazards identified in the simulation that may otherwise have gone unnoticed? No Yes please give a brief description Question Title * 19. If yes to question 18 (above), was the hazard reported to:Check all that apply. Unit Manager/Leader RLS No action taken Other (please specify) Page1 / 2 50% of survey complete. Next