In this episode Jaclyn Jeffries shares her mission and vision as a pharmacist and the impact simulation can have on medication safety. This episode is sponsored by SimVS.

Jaclyn Jeffries received her Doctor of Pharmacy Degree from Purdue University and completed a pharmacy residency at Purdue’s Center for Medication Safety Advancement. Jaclyn was then Medication Safety Officer for a 4-hospital system, Health-First. She earned her Consultant Pharmacist license in 2014 and became a Board Certified Professional in Patient Safety in 2018. In 2015 Jaclyn joined AdventHealth serving many roles as Clinical Pharmacist, Medication Safety Coordinator and Officer and since 2020, the Executive Director of Safety for the 50-hospital system. She now oversees several safety programs including medication, imaging and perinatal and leads the Patient Safety Academy, Safety Culture Survey and Patient Safety Surveillance teams.

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Transcript

Disclaimer: 0:00

The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of anyone at Innovative Sim Solutions or our sponsors.

Sim VS Ad: 0:13

Thanks to Sim VS for sponsoring this week's episode. Simulation helps develop the mindset of patient safety by allowing learners to practice and fail in a safe environment. Sim VS designs tools that contribute to the development of this mindset. We are excited to release our new four pump simulator. Practice Primes proficiency! To learn more, visit www.simvs.com.

Intro: 0:41

Welcome to The Sim Cafe , a podcast produced by the team at Innovative Sim Solutions, edited by Shelly Houser. Join our host Deb Tauber and co-host Jerrod Jeffries as they sit down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation, sit back, tune in, and learn something new from The Sim Cafe .

Deb: 1:22

Welcome to another episode of The Sim Cafe. And today we are so fortunate to have JaclynJeffries. We have our co-host Jerrod Jeffries and his sister Jaclyn. Let's go ahead and Jaclyn, why don't you tell us a little bit about yourself?

Jaclyn: 1:40

Yeah, absolutely. So I'm a pharmacist by trade and shortly after that I realized that from a personality reflection standpoint that I really liked to globally impact the healthcare system, not so much on that , that patient to patient standpoint. And so I did a , a residency in medication safety and that's really where I found my passion, identifying efficiencies, helping out my clinicians, but then on a more broad scale, impacting our patients . And recently in 2020 I was looked it up to my corporate space where I'm now the executive director of safety. So not so much in just the medication safety space, but in other pockets of safety.

Deb: 2:24

And by trade you're a pharmacist.

Jaclyn: 2:26

Correct.

Jerrod: 2:27

Knowing of that, we we're mostly done a lot of nurses here , Jaclyn, but I think we're, we're pretty fortunate to have you given the pharmacy side. Can you first start off with your journey into simulation, why you're here, what you've done? And we'll start there.

Jaclyn: 2:44

Yeah, absolutely. So Jerrod, as you know, our mother, Pam Jeffries , she is what I would coin her as the simulation queen. So really got exposure at a young age into that simulation space. And I don't think that I truly appreciated what that meant until I was in healthcare myself or, or was an adult learner. And there are different ways of learning. There are different ways of absorbing and applying. And I think very quickly when I was out at work, there's one thing from a computer-based learning, there's one thing from a didactic session, but when you're able to actually tangibly touch, feel, or emote feelings or emotions with a, with a real, either with standardized patients or, you know, we've done a little bit of conversion over to a virtual space for sims , but when you're able to emote those feelings and really walk through that process from a visual nature, from a tactical nature, it's a lot more sticky. And so you not only learn that content, but you can apply that content to a much greater degree. And again, that's my opinion, but I just find that we get better, better results and I actually get better feedback from that when I've used it in my spaces.

Jerrod: 3:58

And when did you start using it from a professional standpoint?

Jaclyn: 4:02

Yeah, great question. So again, as a medication safety officer, so my job prior and knowing the utility, we were looking at a couple of different priorities within our health system. One was our barcode medication administration process. That's where you, you've got a medication, it's a , it's a nurse and you wanna scan the patient to ensure correct patient and then you scan the medication to ensure correct medication that aligns with your electronic health record. And we were trying to raise our numbers to a national benchmark of 95%. So kind of within that launch we designed a barcode medication administration simulation, really focusing on that and the proper technique and getting those learners early so they knew exactly what the expectation was. And then we also shifted to an infusion pump simulation. So that's kind of coupled with the BCMA, but it's a whole nother beast because there are other integrated parts within that infusion pump. And we specifically designed that one around our chemotherapy medications that way , uh, you kind of got the most complicated process within that pump experience.

Jerrod: 5:11

Wow. I , so I haven't heard that before. And how long, one, what year was this? And two, how long does something like this take to develop?

Jaclyn: 5:20

Oh, that's what I'm digging deep. Uh, we probably developed those and I , and I will give a shout out . This is in conjunction with my current medication safety officer, Stacy Carson. I call her. So I call my mom the stimulation queen and she's my pump queen. But we developed those, I'm gonna say we probably looked at those 2018, 2019 and I would say we were probably working on those for about five months maybe just because of t heir different priorities. S o

Jerrod: 5:48

Yeah, it's a , it's a huge effort and , and as we've seen it, it takes such a team and really this focus around collaborative effort. And when it comes to , I think the pharmaceutical side with the medication safety, it takes even more hands because it's, it's probably not, I don't wanna say it's accepted, but it's not as utilized maybe in, in that field. So maybe it can be a little more, did you face a lot of barriers when you were doing this? Or was it kind of phrased by by administration when you were going forward?

Jaclyn: 6:17

I don't know that it was necessarily barriers to be fixed. I think it was more so from a foundational medication safety standpoint. I really focus on that medication safety technology because you know, if I were looking at it as a pyramid, that medication safety technology, again, I think it can impact the most clinicians and patients. So if we get that right, then if we do have a one-off error or if we do have other intrusions of unsafe , you know , human erroror unsafe behavior, we've got that fundamental foundational layer of safety that can hopefully safeguard our patients from experiencing that error if , if our clinicians do error . So I don't know if there was so much barrier correction, but it was setting that expectation, this is what we expected you in proper process for B C M A , this is the goal we expected to achieve, these are the steps in the processes, it's just the way we do it here. Um, and I think that that was consistent for both B C M A and for our infusion pumps. And Stacy and I, we identified that those were two areas of opportunity or two our priority areas. So we just were looking at the whole gamut and we said, okay, these are our , our priority areas, these are our goals or our metrics. These are all the different spaces that we can kind of campaign that out to get that minimal expectation that we need from our team.

Deb: 7:39

Jaclyn , I'm gonna ask you one question. What is B C M A ?

Jaclyn: 7:41

B C M A ? It stands for Bar Code Medication Administration. So that's that a physician can order that medication, the technician can compound that medication, pharmacy will verify it, we'll get that dispensed to the floor. So that last opportunity in the medication use process is the administration. It's very easy there . There's a med room, there's a bunch of meds floating around. So it's very easy for that nurse to potentially grab the wrong medication, administer that. So this is a safeguard that's used again to scan the patient, scan the medication to make sure that you almost close out that appropriate process.

Deb: 8:15

The last line of defense.

Jaclyn: 8:17

It's the last line of defense.

Deb: 8:18

Okay. Excellent. Excellent. Now I'm gonna ask you another question and that is, do you have a favorite or most impactful simulation story that you'd like to share with our listeners?

Jaclyn: 8:33

I do. And it is a more recent one and it kind of, I guess ties in my previous experience up to current state. An event happened back on December 26th, 2017. So quite a bit ago. It was an issue that many of you probably maybe have seen in the, in the news it was redna bot and the Vanderbilt incident where unfortunately one of her patients passed away from a medication error. So of course this ends up getting pushed in the media probably late 2018. And so this is when I first saw it as a medication safety officer and it really impacted me. I mean, I could just feel what that did for that nurse. No one wants to be in that situation. I couldn't imagine what that felt like for that patient's family, for it to be publicized in the news. Um, and just having to relive that as often as it was published and what it had to do for the institution. So in , in my frame of mind, we've got three victims here. We've got not only the patient, the patient's family, we've got the nurse herself 'cause this is just a horrific event that no one wants to have happen. And then Vanderbilt as an institution being the third victim, you know, now they've got this massive media presence on an unfortunate event that happened. So very invested in that event. And then a little bit concerned on a just culture side as well, because this from an error standpoint, typically right or wrong, those are handled within the healthcare institution. You know, there's protection in our healthcare institution, we're all human, we all make mistakes. Exactly .

Jerrod: 10:05

For those unf not familiar though, could you, could you maybe just give a couple sentences about what the case is about?

Jaclyn: 10:10

Oh yes , absolutely. Thanks, thanks. I've been so inundated with it, I forget. Yeah, so unfortunately Redondo Vaught , I guess in short terms , there was a, a patient needed a anti-anxiety medication midazolam or a birthed , and this doesn't do justice to the case at all , but the nurse pulled out on override in the Pyxis machine Vecuronium. So she had typed in VE on the automated dispense cabinet , um, that's where you pull your meds. So she typed in VE did not see Versed, those are both the brand names and pulled out Vecuronium, which is a paralytic, so by mistake and administered the paralytic versus the anxiolytic, which did lead to a patient death. So doesn't do the , the case justice . There were a lot of systematic errors that I think also con that contributes to that event. But in essence, cut and dry , that's what happened. Very invested. And then from a just culture standpoint, this, yeah, this is , this is in the media. This is talking about an an error that this nurse committed for me, I just was thinking, oh no, what's this gonna do to our medical community? Because it felt very outcome focused versus process focused . And my concern with that is the health system's really gone through a continuous journey before it was probably in the, and don't quote me on my dates here, but in the pre nineties it was a very punitive culture where no one wanted to admit their mistakes. Everyone was perfect, which, which didn't lead to a lot of learning or improvements, right? Because everyone's just ashamed of any mistakes that they make and doesn't want anyone finding out. So fortunately ish there's a little transition in the nineties to a blame what is called a blame-free culture. And that's not as far left as punitive culture, but just totally swung to the opposite of the pendulum where it's blame-free, you're willy-nilly, you can make any event, it's human error, no big deal. And what that lacked was really that accountability. So then we swung, kind of got a better middle ground of a just culture where the pendulum kind of neutralized. And that was where we had the ability to share and learn no with the knowledge that everyone makes, mistake everyone errors , but then coupled with some accountability, like you are accountable to your actions . So that's really where we were. And I was really afraid that with this event being as publicized as it was and focused on outcome versus process, that we were gonna swing that pendulum back to the punitive state where people were gonna be hiding their errors knowing that this was drug into a criminal case. Yeah, thank you. Yeah, so that's, I just gave you a bunch of background on that case, but in essence, she actually got sent to a criminal trial march of last year, March of 2022. And that was really when the nation started paying attention. And what I've done, I lead a patient safety academy at our health system at the three day patient safety academy, really targeted to our chief clinical officers and then those in our leaders in quality, safety, and risk . And I incorporated this case into that academy twofold. We've got some of, we've got a video clip from her trial which really evokes that emotion and then walking through a lot of those steps that led up to, and then we walk through our just culture algorithm in a simulated environment so that our clinicians can evaluate the process of that case

Jerrod: 13:44

In this patient Safety Academy is only for people within Advent Health or is this an external one or ?

Jaclyn: 13:51

Great question. Yeah, it current state, it is just to Advent Health , it's our Advent Health team members.

Jerrod: 13:57

You help put this on and lead this or what's your involvement in the course?

Jaclyn: 14:01

Within my role now I lead that program and so back in 2021 I took the Reign, I really revamped the curriculum to align with something called High Reliability Healthcare Framework. And within that there's a culture component. So this is not only do we teach that theory, but we also teach this practically. And I insert that sim in using that just culture algorithm for our institution.

Jerrod: 14:26

I feel like you, with your position, are you getting requests from external members to participate in this or?

Jaclyn: 14:34

I have not, but an internal standpoint. So we're a little bit, not limited, but we've got a leadership institute which accommodates about 45 individuals prior to this year . We hosted those twice a year , um, about 45 individuals . And then because of the, the great response we've received, we actually expanded that out to three times per year. So we hosted March, June and September, we just graduated our 12th academy class. I just graduated my five since I've been leading it, but we also graduated our 500 graduate, so we just ended one end of June. But every time I am going through that academy and complete that course, we get a swell of interest stating it needs to go through our entire organization. So not just these 45 cohorts, but every single individual needs to go through it. Our entire medical staff, all of our C-suite. So there's a swell internally, I don't do any external marketing. You know , there are other patient safety conferences, but I do feel strongly in this one. And you know, if , if it were to ever go external, I think that that would be a great opportunity.

Jerrod: 15:42

I feel like it's pretty innovative within the field. But then a follow up question would be is where do you see the future of simulation going or, or what's next within it?

Jaclyn: 15:52

From an adult learning standpoint, we've gotta be doing different things . What we did, I guess I'll speak a little bit to what we did from a pandemic standpoint. So before we would, before in the academy we had our, our standardized patients and clinician, we kind of set one of those single afternoon days where we'd bring the props, we'd bring the standardized patients and clinicians to our institute and go through real life simulation . And then when Covid hit, we had to pivot and do that virtually. So I worked with the simulation center and what we did is we basically took those same sim cases, the sim same sim scenarios and we converted those to sim videos. So we recorded basically what we wanted to capture those attendees would be seeing in person and then the breakout rooms. And so I created a facilitation guide for my standardized facilitators to kind of walk through, what are those freaking parts, what's that briefing, what's that debriefing look like? And then we pulled them back together and did a big group debrief to kind of hit on some of those key points. So an answer to your question. So we pivoted that and then of course in that pivot my stewardship went up significantly. It saved the programming a lot of money by shifting, you know, paying those, those standardized patients and clinicians bringing the props. You know, from a logistics standpoint and from a cost standpoint, we saved a lot of money converting over to virtual. So I actually kept that tactic. And I also liked that it standardized what those different breakout groups would experience. You know, they the same videos, so depending on ability of the standardized patients and clinician, it also standardized that briefing and debriefing conversation. So I kept that. I didn't go back to the in-person sim . And so what I see for simulation, we've gotta keep being iterative , we've gotta keep being innovative on how we capture and teach our adult learners. I mean there's so many different distractions you can see from a didactic portion. Those hour, long hour and a half long talks just aren't keeping people engaged or keeping people's attention . And I also find that simulation, if you're really wanting to get that tangible effect, that that feeling, they've gotta feel, they've gotta be part of it. So there's a lot of different utility just may shift and not look the same from what we're thinking about with mannequins or in-person people. It's just a different way to think about it.

Deb: 18:18

I think you kind of answered this, but let's make sure that what lessons were learned during the pandemic and do you have goals that are altered essentially, you know, maybe 1, 3, 5 year goals since you learned that .

Jaclyn: 18:32

Touch on it just a little bit. Really converting from that in-person simulation where we brought in the standardized patients and clinician where we brought in the props and we kind of did a full afternoon of sim , the way I pivoted was shifting that to virtual doing videos and then I was able to, instead of doing a big block of sim , I've now got them coupled with that didactic portion that they're taught. So it's spread out versus in one big chunk, which then really applies and emphasizes the content that they were just taught. So that's one way that I pivoted in terms of one to three to five year goals, I think we're gonna continually be evolving, just like there was the hour and a half didactic presentation, now you're seeing a more TED talk style where it's 20 minutes. Same thing with the sims . I know I anticipate my cases changing or the content, you know, like right now I focus on essentially the errors that we're seeing most commonly or the things that our clinician leaders are having to encounter and discuss. I do that from a priority standpoint looking with , working with my risk managers. So that will tweak as we get better hopefully with the current errors. And then introducing those new priorities. I don't even think I can predict one to three to five years just of the , the rapid pace of technology growing, what that exactly will look like.

Jerrod: 19:55

You just say ai, ai, ai, ai , <laugh> ,

Jaclyn: 19:57

I don't wanna say AI that's way too broad's, way too broad.

Jerrod: 20:01

I'm Teasing.

Deb: 20:02

Well, and I think you and I talked a little bit about medication errors and putting medication errors into scenarios where the clinician makes a medication error and how does that actually follow through? I've been asked that by one of our listeners , uh, Billy Martin, about the vulnerability of making a medication error and the process that goes along with it. What do you do afterwards? You have to fill out all these reports. Do you go ahead and talk to the family? Are you part of that mitigation that, that the family members and patients understand that there was an error made? So what are some of your thoughts around that? And I know that's a big question.

Jaclyn: 20:44

No, I think it's an excellent question. So we do do a portion of that, but definitely opportunity for that last remainder. So the beauty of stems is that you get to practice those things that you rarely encounter that are super uncomfortable, that aren't familiar, that you just basically have not a lot of experience with and or things that could result in catastrophic error harm that you really wanna stimulate it if you go into the real environment with that, because we're looking at, because my cohort for this academy is, is leaders. I don't have frontline clinicians in there. I really focus on what that response or what that approach is. So not only using the just culture algorithm that way we focus on the fact that it's evaluated fairly looking at the process, again, not outcome , but also that we foster a learning system. So we're learning from that event, we're transparently sharing that event with the team to learn from it. But then also we do do a couple of crucial conversation type responses. So again, we've got it standardized, we've got one actress in there doing that as the both the clinician that's aired and the the nurse manager in this case. And so you can see that interplay or that crucial conversation happening. And of course there's opportunity for improvement there and there are different styles that are there. So that is something that we focus on from that leadership standpoint is not only the event itself and then what we are doing as an institution to, to foster a safer space regarding that event. That's one debriefing. But then the second debriefing is really focused on that, that crucial conversation, how that leader's showing up or what other tips and tricks do the leaders in the room have for either making that conversation a lot more comfortable, giving them a little bit of practice and doing that crucial conversation so they just feel armed with those tools when that likely inevitably happens in their space . We don't do, like when we were talking, you did ask about the disclosure to the patients and the families . That's not something that I've incorporated into the academy current state, but I think that's an excellent idea. I know there are other institutions that have that in terms of video and have that in terms of training for their clinician, but it's not something that I've incorporated, but I think it's an excellent idea.

Deb: 23:03

Thank you. And I think that talking about some of these uncomfortable things helps to make them more normal. I can tell you that as a clinician, anytime the thought of making a medication error, there's this awful feeling and anybody who's in healthcare is a nurse or physician that when a medication error is made that just comes to the pit of your stomach. And you know, we have to recognize that that's a real thing. It's a physiological thing and you know, what do you do then? Right? What do you do next?

Jaclyn: 23:34

Yeah, absolutely. I mean there's so many different appropriate inappropriate responses, right. And we don't always show up, but yeah, absolutely. I mean there's a lot of shame involved in making that error almost like a , there can be a frozenness, there can be, I mean not only physiological, there's the mental, there's the emotional, which then can impact the physical. I mean there's a , there's a lot. And I think that's the beauty of doing these sims . Yeah, you said it, it almost normalizes, but then it , that conversation again, it's called a difficult conversation or a crucial conversation for a reason because we're not practice , we're not familiar. So giving them that space to practice to become familiar, it almost makes it less intimidating or less hard to have those conversations successfully and show up for the team or for that individual the way we need to. Thank you

Jerrod: 24:25

Certainly. And Jaclyn, through your journey has been extremely interesting, I'll put it that way for probably lack of a better word. But with these difficult or critical conversations, these different styles or experiences, what would be , uh, something that's changed the way you practice or changed the way that you've, once you've learned it or experienced it that made you kind of see the world or this profession a little differently?

Jaclyn: 24:50

That's a great question. So often we are so uncomfortable with it, so it is delayed or it's brushing or the rug or it, it's just not confronted. And I think in seeing this, I've developed maybe a couple of mantras and I'll quote Brene Brown being one clear as kind. And the other one is, how would I wanna be confronted or what would I want to have happen? You know, it's kind of like the golden rule. So I think in developing this and watching how our leaders respond, that's kind of changed the way I lead as well. I don't delay, I don't defer. I have those conversation, it almost a radical candor type concept because I would wanna be told I wouldn't want be aloof or , or have this thing lingering or be told even three days, five days after the event, the incident.

Jerrod: 25:45

I , I love that because I , I do feel like so many times I would, I wouldn't even say this profession, but us as humans, we delay those difficult conversations and I mean, maybe you used it , heard the expression kicked the can down the road and it's just like you delay it, you delay it, you delay it, and then those difficult decisions, one, don't get any easier. But two, it's just one, it's wasted time or it's, it's really just said, okay, now you're in a difficult spot, even more so. And I think there's a saying of, you know, hard decisions now, easier life later, vice versa, easy decision now, harder life later. And so it's, it really goes into, you know, this clearest kind because one, we can't read people's minds, but you're really trying to say, this is what you want, this is the learning objectives, this is the scope of practice, this is what we need. And I think that what you've been saying here is , is exactly true to many facets of life, but most in particular when it comes to some of these , uh, simulation pieces.

Jaclyn: 26:40

Thank you. Yeah, I mean Debbie mentioned physiological, I mean if you're holding it in it's festering, you're kicking it down the can. There's that period of time where the other person doesn't know what's in your head and then that probably will prolong the festering to the other individual. So it's just not kind at all for any account. Then that question in that person's head can be like, why didn't you tell me earlier? Like, if this is a problem, why didn't you sit on it? So it's almost an empowering thing, almost eating your emotions or the way you perceive that they're gonna react and know this is the kindest thing I can do to me and to that person.

Deb: 27:16

Thank you. And I think a , a lot of our listeners will hopefully, you know, learn something from this and take away from that silence. When you create that silence and don't do the clearest kind, all that individual has to do is just ruminate in their mind about the what ifs, the what's gonna happen to me. I mean, there's nothing worse than having the someone say to you, we'll talk about this later. And then all you think about is, oh my gosh, what is that gonna look like? What, what is, what is gonna be said? And when is later? Right? And your life kind of is on that stop

Jaclyn: 27:53

And then you're no longer fully present. You're thinking about, oh shoot , what did I do? Yeah,

Deb: 27:57

Yeah, yeah, yeah. That used to be an old tactic. Wait till you get home, we'll talk about this later.

Jaclyn: 28:04

And that is not kind .

Deb: 28:06

<laugh> . Alright , well thank you. I have another question. And are there any final words that you would like our listeners to remember this conversation by?

Jaclyn: 28:18

Oh , that's a great question. Yeah. I think everyone practices, you know, everyone practices in different ways and simulation is certainly one way of practicing than becoming more comfortable. Becoming more skilled. And I think that that's the way we should approach a lot of these, these hard things or uncomfortable things, unfamiliar things, practice doesn't make perfect, but it makes you a lot more confident and comfortable and I think simulation's one vehicle to do that.

Jerrod: 28:48

I like that.

Deb: 28:50

I really like that . Yeah , I like that as well.

Jerrod: 28:51

I like those final words. I haven't heard that before, but it's, yeah, and I think between the difficult critical conversations and the, and the transparency of around just aligning expectations, and it's not about finding the balance, it's about saying, this is what your role is and responsibilities are, there's other outside factors, but you know, we, we gotta make sure that if you're uncomfortable or things get too busy for you, we gotta communicate that back. And it does go both ways. But I think as you even brought up with the, with the case too, there's a lot of situations where, you know, a lot of these things are swept under the rug. And I think you shine a lot of light on where simulation continues to progress and how we are always evolving, practicing, innovating. Unfortunately, probably not as quick as any of us want, but at least progressing in the right direction over time.

Jaclyn: 29:45

Yeah, absolutely. I mean , at the end of the day, yeah, there's a , there's a tech component, but there's a people component, you know, and at the end of the day, we all wanna feel loved and feel like we've got some sort of belonging. And I think when you approach your team, I mean as a parent, coach, mentor, leader, friend, significant other, if you approach those situations as people, you'll succeed. You know, you'll lead with a lot more empathy, with compassion with that heart, which I think is super valuable as we try to create teams, foster trust , transparency , and that great culture.

Deb: 30:22

Thank you. I appreciate all of your intentional conversations and the things that we were able to touch upon today, which you know, do include vulnerability and being human, right? Yeah, yeah,

Jaclyn: 30:37

Absolutely.

Deb: 30:39

All right , well thank you very much.

Jerrod: 30:39

Thank you Jaclyn!

Jaclyn: 30:40

Thank you both. I appreciate the opportunity.

Deb: 30:43

Thanks. Happy simulating.

Sim VS Tag: 30:48

Thanks again to Sim VS For sponsoring this week's episode. Check out SimVS .com to learn more about their new four pump simulator.

Outro: 31:05

Thanks for joining us here at The Sim Cafe. We hope you enjoyed. Visit us at www.innovativesimsolutions.com and be sure to hit that like and subscribe button so you never miss an episode. Innovative Sim Solutions is your one stop shop for your simulation. Needs a turnkey solution.