Case Overview: Ida Mae Homer is an 80 year-old woman with a 5-year history of Alzheimer’s disease.  Her granddaughter has been staying with her for the last 3 days while her daughter (her usual caregiver) is out of town.  Mrs. Homer is becoming increasingly confused and agitated with increased urinary frequency and incontinence as well as insomnia.  Her granddaughter has tried using Benadryl to help her sleep, however nothing seems to be helping.

Simulation: The set-up for the simulation includes the medical and nursing students reviewing a delirium web module (POGOe #20503) as well as a Situation, Background, Assessment, Recommendation (SBAR) video attached on the right side of this page, then completing pre-test delirium assessment (Delirium Knowledge Survey) and an assessment of attitudes toward teams in training (KidSIM) prior to the simulation.  Next, each medical and nursing student pair meets approximately 10 minutes prior to the simulation to review instructions, introduce themselves, and discuss thoughts and plans for caring for an agitated patient.  The team is then escorted to the “Emergency Room” where the patient and granddaughter (both are standardized patients) are waiting (faculty observes from control room).  The patient is agitated and anxious and is trying to get out of bed.  The team should elicit information from the granddaughter and recognize that the use of Benadryl and the probable urinary tract infection are the likely etiologies of delirium.  The team has a variety of medications available on the med cart (lorazepam, haloperidol, morphine, and hydroxyzine) as well as restraints, and the patient has “IV” access.  The simulation lasts 20 minutes, and approximately 10-15 minutes into the simulation, once the patient is stable and a plan has been established, the medical student calls the “attending” in the control room, and using SBAR, checks out the patient over the phone.  The faculty member then ends the simulation, and the entire team (faculty member, 2 students, and 2 standardized patients) leave the room for an approximately 15-20 minute debriefing session.  Simulations can run staggered if there are resources to have 2 teams and 2 standardized patients, otherwise the next simulation would begin once the debriefing session ends.

Goals for the simulation and topics for discussion during debriefing session:

1. Diagnose delirium using CAM
2. Identify potential causes for delirium
3. Identify appropriate pharmacologic management for delirium (medication as well as dosage)
4. Inter-professional collaborative practice
5. Situation, Background, Assessment, Recommendation (SBAR)