Mr. Samuel (Role)
• Okay, okay, my name is Mr. Samuel
Steinberg, and I’m 87 years old.
• Now will you help me?
• No, I’m not in pain, and I don’t need to
go to the bathroom.
• What I need is to get out of here!
• I really need to go home now.
• I need to take care of my dog and
watch my stories.
• Ask again about pain and comfort
• “Yes, I will help you”
• “Let’s sit in the chair after we go to the
bathroom, and then I will call the doctor”
• “Where is your home?”
• “Tell me about your dog. How is your
• “I understand your daughter is taking
care of your dog”
• “What kind of dog is it?”
• Report to doctor; include delirium
assessment (confusion assessment
• Any new medications causing this?
• Pulse oxygen, lung sounds, sleep pattern,
patient-controlled anesthesia pain,
current medications, fluid intake
• Vital signs (low-grade fever, increased
respiratory rate); is patient stable?
• Laboratory tests?
• Postoperative state? Highlight lung
sounds; oxygen saturation changed with
• Move slow and cautiously
• CARES (Confusion
activity cart items
• You did a good job
• How do you further assess
signs of confusion?
• Look through chart
• Check medications
• Oxygen saturation, lung
• Check pain
• Last pain medication
• Bowel movement
• Fluid intake
• Consider new medications
• The doctor is on the phone
• Would you like to give a
• Provide safety
individuals from different disciplines
to work in teams. To maximize the
use of resources and limit participants’ time away from the clinical
area, the administration planned and
supported a daylong program that
included didactic education, videos,
group work sessions, and the simulation sessions with resource team
members as coaches.
All participants attended an hourlong introductory didactic lecture together. Then, they were
randomly assigned to 1 of 4 remain-
ing 45-minute training sessions. Each
participant attended a session that
combined a video and a case study;
a session of role-playing with group
discussion; and 2 simulation scenario
sessions. Concurrent training sessions were needed to facilitate having
all 100 attendees participate within
6 hours. Attendees were multidisciplinary providers from various
non-ICU medical/surgical units and
outpatient geriatric clinics. They rotated among sessions to accommodate all participants.
For the simulation scenarios, 8 simulation rooms were used over 2 peri-
ods—for 16 simulation sessions total.
Participants were randomly assigned to
multidisciplinary groups that worked
in teams to assess and recommend care
and treatments for SPs who were stimulating delirium. During the simulation,
delirium coaches used cue cards and
verbal hints to direct teams (
Simulation Exercise). After the session, participants received verbal and written
feedback from the delirium coaches
and the SPs, using a standardized
checklist. The simulation center with
its multiple lecture halls and simulation laboratories facilitated meeting
these challenging requirements.