Dec 23 Build APSS Transitions

July 22 Build

Check this assessment piece for Sylvia's case

This is one of Sylvia's latest assessments. It could use another set of eyes.




https://s3-us-west-2.amazonaws.com/knowledgeinnovation/APSS/Sylvia+Assessment++%23+3++-+Storyline+output/story.html

July 5 Build

This has 2 assessments complete, Su's and Andy's. One left to do.

Please check Andy's for wording etc.




 https://s3-us-west-2.amazonaws.com/knowledgeinnovation/APSS/July+5+Stroke+Transitions+-+Storyline+output/story.html

July 4 PM

Revised.
Still love my words, so I spaced them out through time.
Again

Hows' the wording ?? Does this work? Any other thoughts ??

July 4

This is where we are at:

Working on the assessment. Hows' the wording ?? Does this work? Any other thoughts ??

Latest Build June 24

This is where we are at:

Cleaned up the left menu and various links. Currently, Su's is the most complete case study, I will be adding the assessment for Andy and Sylvia and modifying some images to finish things.

June 17

This is where we are at:


https://s3-us-west-2.amazonaws.com/knowledgeinnovation/APSS/June+17+Stroke+Transitions+-+Storyline+output/story.html

June 8

https://drive.google.com/open?id=0B-9ZA7n0tr49TmhhX3hLUHREdm8

June 6 Part C

https://drive.google.com/open?id=0B-9ZA7n0tr49dmpxZkFRZXZIT0U

June 6 Mas Tarde

https://drive.google.com/open?id=0B-9ZA7n0tr49RkNnX2ZLUTFEV2c

Where Are We ??

So what's left ?
Your job is to find bugs . . . .
The cases all end now at Where are they now?
I will add the assessments and clean it up a bit more.


https://drive.google.com/open?id=0B-9ZA7n0tr49czJXekNlOUNKeEE

June 2

https://drive.google.com/open?id=0B-9ZA7n0tr49UG94OUlDQlFtYUE https://drive.google.com/open?id=0B-9ZA7n0tr49UG94OUlDQlFtYUE

May 27

So what's left ?

Please check out Su's case.

Next we need to think of some review questions or challenges.c2 to 3 per case.

I am also trying to think of a summary or conclusion for each case, so your help would be welcome there.



https://drive.google.com/open?id=0B-9ZA7n0tr49Nks2ak0wemIxTGc

May 26

https://drive.google.com/open?id=0B-9ZA7n0tr49TV9qTlA0WHBSalU

May 25

https://drive.google.com/open?id=0B-9ZA7n0tr49OURybTZUcmFhaDg https://drive.google.com/open?id=0B-9ZA7n0tr49M3NzcHBzeEY3aE0

Most of Su's case is in place . . . last question for Su and Assessment left

https://drive.google.com/open?id=0B-9ZA7n0tr49OURybTZUcmFhaDg

https://drive.google.com/open?id=0B-9ZA7n0tr49M0ZnMm9lbFRMVzQ

May 16

https://drive.google.com/open?id=0B-9ZA7n0tr49Q3N0VnpBNGQ4Y3M

May 11 + 4 = Fixing lag from May 13

Back tracked to fix lag that crept in again.


https://drive.google.com/open?id=0B-9ZA7n0tr49OHhpZTBDWkJRNnM

May 13 Friday Sylvia's intro video added

This version has lag issues again. Will replace shortly.



https://drive.google.com/folderview?id=0BzOf3pwBLLnHWXlYdFRfbVZRclE&usp=sharing

https://drive.google.com/open?id=0BzOf3pwBLLnHWXlYdFRfbVZRclE

SYlvia's Build

https://drive.google.com/open?id=0B-9ZA7n0tr49aHllUjNlaTZ4cVk

Su's Script

The final Chapter !!  Here it is Su's story.




https://drive.google.com/open?id=1uYnSknmY2H_NsM3r8hLnQha9oETjgOs8tCfiRfDYECs

REVISED May 5 Sylvia's Winding Down, Getting Ready for Sue

Updated
So the SMEs found some questions were unplayable !!!! The spinning ball of death kept spinning on questions 3 and 6.
Thankfully my last build was 2 days previous so I can fix this by going back to the previous build. Thank goodness I'm a developer with packrat tendencies
Time to Tidy up Sylvia and move Up to our last case study !!!!!
 

https://drive.google.com/open?id=0B-9ZA7n0tr49TWQ4bk5HRnY4X1U https://drive.google.com/open?id=0B-9ZA7n0tr49dkpvdjRKOWd6UzA https://drive.google.com/open?id=0B-9ZA7n0tr49TWQ4bk5HRnY4X1U

May 3 Time to Tidy up Sylvia and move Up to our last case study !!!!!

Time to Tidy up Sylvia and move Up to our last case study !!!!!
  https://drive.google.com/open?id=0B-9ZA7n0tr49dkpvdjRKOWd6UzA https://drive.google.com/open?id=0B-9ZA7n0tr49dkpvdjRKOWd6UzA

April 28

Over half way through Sylvia's Story. Working thru Transition 3 of Sylvia.
  https://drive.google.com/open?id=0B-9ZA7n0tr49WS1sbnBvQ0VSVTQ https://drive.google.com/open?id=0B-9ZA7n0tr49WS1sbnBvQ0VSVTQ

April 26 Sylvia Case study

We are nearing the end of the sceond case study branching scenario.
  https://drive.google.com/open?id=0B-9ZA7n0tr49a19EaHdCcGZ1cFk https://drive.google.com/folderview?id=0B-9ZA7n0tr49a19EaHdCcGZ1cFk&usp=sharing

April 22

  https://drive.google.com/open?id=0B-9ZA7n0tr49SWhTaXpvSVNCQVE https://drive.google.com/open?id=0B-9ZA7n0tr49TnNLNGVsbmM3SjA

We Are On To Sylvia !!!

Sylvia has begun !!


  https://drive.google.com/open?id=0B-9ZA7n0tr49SWhTaXpvSVNCQVE

Great work  on the script rewrite on Thursday. We were all clicking along that afternoon. Now if we can get the other half of  the script for Sylvia's case study.

Green Checkmark or Blue fade for Visited Branch.

So I changed the first 3 questions to see how the blue fade worked as a designation for this branch has been visited rather than the green checkmark.





https://drive.google.com/open?id=0B-9ZA7n0tr49VHl0M2dTMXBiZEk

New Su

My mother, Su is 78 year old and lives in Calgary.  My dad died 5 years ago and she has been living on her own since then. I live in Manitoba with my husband and 2 young children.   My younger brother is single and lives in Edmonton.  My older brother lives in Calgary with his wife and their 2 young children.   3 weeks ago Mom had a bad stroke.  Her neighbour found her lying in the garden and called 911.  My mom is in the hospital now but she can’t speak very well and can’t swallow so the nurses feed her through a tube.  She also can’t walk and so they use a mechanical lift to move her to a wheelchair.

My mom, my brothers and I had a meeting with some staff from the hospital and we all agreed that Mom can’t live by herself anymore and so she will have to go to a long term care home where there are people who can look after her. 

What information should be included in the discharge summary?

?Learner lists ideal summary - compares to exemple - Learner adds omissions, corrections.

April 12

So I  have been working around Question 7 and moderating the whole driving issue so that is a more muted response.

I still have a couple of tweaks to final answers in question 7. Currently they  are marked under construction.

Hopefully Sylvia will be off and running PDQ.



https://drive.google.com/open?id=0B-9ZA7n0tr49c0RQWnBGSm9vVjA

TIAs Strokes and Driving

This is what I have used as my support and evidence for driving protocols after a stroke incident:

Driving a Car After a Stroke

https://myhealth.alberta.ca/health/pages/conditions.aspx?hwid=zp3396

Driving a Car in Alberta After a Stroke

https://myhealth.alberta.ca/Alberta/Pages/Driving-a-car-in-alberta-after-a-stroke.aspx

Driving after a Brain Injury

https://myhealth.alberta.ca/Alberta/Pages/driving-after-brain-injury.aspx

March 30

So I   tweaked the menu flow some more, building scenes ( it's those drop down menus in the menu) so that the other case studies will follow that process making the menu manageable for 4x the number of cases.

Still plodding along on beginning Sylvia's story ( Nothing to see there just yet, stay tuned).

Trying to envision the intro video.



https://drive.google.com/open?id=0B-9ZA7n0tr49cnlyamVBUl96T0E

March 28

So I have been tweaking Andy's story and working around the edges based on suggestions that have come in for Andy's story.

 I am slowly beginning Sylvia's story ( Nothing ot see there just yet, stay tuned).

Your feedback moves this project forwards.

Thanks



https://drive.google.com/open?id=0B-9ZA7n0tr49OHNqZ1U4SVlpUGM

March 24

https://drive.google.com/open?id=0B-9ZA7n0tr49dllEUmtEWmxHbGs

March 22

https://drive.google.com/open?id=0B-9ZA7n0tr49N2V5eHo0cFJWajg

March 21

https://drive.google.com/open?id=0B-9ZA7n0tr49OUdsUk05YUJiRWc

March 13

https://drive.google.com/open?id=0B-9ZA7n0tr49MTVUR2Y3SU1wMkU

March 7

https://drive.google.com/open?id=0B-9ZA7n0tr49ZnJjVURBWGNiUDg

March 3

INTRO

March 1 Andy

https://drive.google.com/folderview?id=0B-9ZA7n0tr49RnRIeXpjc2FLd0E&usp=sharing

Latest Andy . . . .

https://drive.google.com/open?id=0B-9ZA7n0tr49QVBWV1FJUUplbm8

Andy- Simplified RR Wow! What just happened? I was driving into town when my vision got blurred and I couldn’t see much for a while. Then, when I got out of the gravel truck, I lost my balance and fell back against the seat. Good thing my co-worker got me to the Emergency department quickly. I’m feeling better now, but the doctor thinks I might have had a mini stroke. He says he’s going to need to send me for some tests. I have to be transferred to another hospital for a scan of my head and arteries in my neck I’m not sure why. What teaching do you think Andy is ready for at this time? a) Information about what minor stroke is (yes) b) Description of the CT scan and CT angiogram and information it provides (yes) c) Review of all risk factors for stroke (NO) This information would be better provided after diagnosis is confirmed and patient is seen in the SPC How can Andy’s transition be supported smoothly between Healthcare Centres? a) Completion of inter-facility transfer form b) Completion of CT requisition with appropriate history c) Verbal communication with EMS Dispatch d) Provide CT requisition to patient and tell him he’ll hear from you soon (NO) Communication must happen between caregivers and results need to be available today So after the scan, the doctor gives me Aspirin to take and says I can go home, but I need to be seen by a stroke specialist in Edmonton tomorrow. I wonder how that is arranged. My wife and I feel a bit overwhelmed and anxious. What if it happens again? What teaching is appropriate for Andy at this time? a) Review how Aspirin works to prevent stroke b) Provide list of community supports (NO) This information would be better provided after patient is seen in the SPC c) Have the emergency physician explain why he/she does not think admission is needed d) Review signs of stroke and advise to call 911 if they occur How can Andy’s transition be supported between the Healthcare Centre and Stroke Prevention Clinic? a) Complete SPC referral form and fax to appropriate location b) Review TIA Discharge information and advise Andy not to drive until further assessed c) Determine Andy’s resources to get to the SPC in the city d) Ask wife what her specific concerns are about managing over the next 24 hours Today I saw the stroke specialist. He reviewed the scans and said there was no evidence of stroke, but he said I had a TIA. The doctor thinks it may have been caused by my high blood pressure, but I need more tests. He said he was going to increase my medication for my blood pressure. I also found out that I have to have some vision testing before I can return to driving. My son drove us to this appointment as my wife doesn’t drive either. We are worried about my job and getting around if I can’t drive. What teaching is appropriate for Andy at this time? a) Review risk factors for stroke and lifestyle changes b) Provide information regarding tests and preparation c) Provide information regarding home BP monitoring d) Provide information about hypertension and CDM education programs How could Andy’s transition be supported at this point? a) Provide information regarding community transportation options and contact info b) Complete referral to dietician for information on reducing sodium in diet c) Assist Andy to obtain an appointment for vision testing d) Ensure prescriptions are provided to patient or faxed to pharmacy e) Complete a depression screen and refer as necessary (NO) This may be too early in his recovery but should be considered in follow up Today I saw my family doctor in the Primary Care Network. He said he had received a letter back from the stroke specialist I saw 2 weeks ago. He reviewed my blood tests and told me my bad cholesterol was high, so he was starting me on a statin medication. He had a copy of the vision test I had last week and said it was normal. As well, the heart monitor I wore for 48 hours did not show any abnormalities. He said that since I have not had any recurrence of symptoms and my blood pressure has been good, that I could return to work next week. What teaching/ assessment is appropriate for the PCN nurse to do at this point? a) Review home BP measurements and re-enforce education on hypertension management b) Review information on lipid lowering medication and diet to reduce cholesterol c) Review signs of stroke and advise to call 911 if symptoms reoccur d) Assess for readiness for change in lifestyle and support him in that area

Intro to Andy . . . . ??

New Improved

https://drive.google.com/folderview?id=0B-9ZA7n0tr49V0FCVy1vQ2lhbGM&usp=sharing

Latest Build . . . Tuesday after Valentines . ..

Things I still have to work on . . . 

1.  Making the slides run smoothly from question to question
2. Putting different  pics in  . . .  the main choice girl is copyright
3. Finding pics and pieces for some answers
1. As an example for the How aspirin works I hilighted in RED so you know this space needs help form you.
4. The  left menu you see will likely not exist in the final product, It just helps getting around this prototype.
5. 
   

https://drive.google.com/open?id=0B-9ZA7n0tr49TngyMVRVWGdMdGM 0B-9ZA7n0tr49WDN5S0JQSUVQRzg

LAtest Script Write

Thursday Draft

New Questions for Andy First Scenario

https://drive.google.com/open?id=0B-9ZA7n0tr49TngyMVRVWGdMdGM

• What if we give examples instead of just these answers?? Like APSS approved samples to look at rather than these headings ?

What teaching do you think Andy is ready for at this time?

• a)       Information about what minor stroke is (yes)
• http://www.webmd.com/stroke/news/20100415/can-you-recognize-symptoms-of-minor-stroke
• b)      Description of the CT scan and information it provides (yes)
• https://en.wikipedia.org/wiki/CT_scan
• 
  
• c)       Review of all risk factors for stroke (NO)  This information would be better provided after diagnosis is confirmed and patient is seen in the SPC
• http://www.heart.org/idc/groups/stroke-public/@wcm/@hcm/documents/downloadable/ucm_309713.pdf

How can Andy’s transition be supported smoothly between Healthcare Centres?

• a)      Completion of inter-facility transfer form
• b)      Completion of CT requisition with appropriate history
• c)       Verbal communication with EMS Dispatch
• Provide CT requisition to patient and tell him he’ll hear from you soon 

A snapshot based on Shirley's latest script . . .

So we might give very brief snippets of each case scenario. Present  Part A and ask:

• What is the Patient ready for ( Teaching wise) ?

• What do I need to do Transition wise to improve his current journey (and his family)  thru the healthcare system? ( and maintain continuity)

A snapshot based on  Shirley's latest script . . .

Andy Case Scenario

Case Scenario- rural Andy, a 63 year truck driver, was just returning to the worksite after a delivery in the country. As he approached the traffic lights leading into town, he suddenly felt dizzy and then lost his vision.

1st Medical visit Transition

 Although in a panic, he was able to radio for help and a co-worker brought him to the local Healthcare Centre. On arrival at the HCC, his vision was improving, so the ER physician did not feel admission was warranted. Arrangements were made for Andy to be seen as an outpatient at a tertiary Stroke Prevention Clinic the following day. Andy’s wife was there to drive him home, but looked alarmed when he was being discharged.

Questions / Learning 

What teaching/ information should be provided before Andy and his wife leave the Emergency Department? (Identify 5 topics and use Patient Education across the Continuum chart) a. Current diagnosis (TIA/Minor Stroke) b. Signs of stroke and what to do-call 911 c. Diagnostic tests for cause of stroke and TIA d. Information about driving after stroke or TIA e. Importance of follow up with stroke specialist f. Importance of follow up with Primary Care Physician g. Potential causes of event and risk of recurrence h. Accessing resources and stroke support following discharge

Transition Scenario

Questions / Learning 

 As a HC Provider in ED, what forms or protocols are available to you to support Andy’s transition to the next level of care? (Identify 2) a. TIA/ Minor Stroke Order Set b. Stroke Prevention clinic referral form, completed and faxed c. TIA Discharge Information Sheet/ Checklist

Transition Scenario

Questions / Learning  ( Caregiver Assessment)

 Prior to Andy and his wife leaving the ED, what caregiver assessment should be completed? a. Confirm wife’s ability to drive patient to appointment b. Determine understanding of plan of care c. Provide opportunity to express concerns, get clarity

Caregiver Dialog Link

2nd  Medical visit Transition

 Andy was seen at the SPC where he had a head CT and CT Angiogram and was found to have had a small ischemic stroke. A repeat visual exam at the SPC confirmed a persistent loss of peripheral vision and a mild balance problem. Andy was advised not to drive due to the visual deficits, and could therefore not return to work. He was given a prescription for Aspirin 81 mg and Crestor 10 mg daily and was advised to buy a Blood Pressure monitor and check his BP daily. He was also advised that he would be scheduled for a Holter Monitor test and should have some rehab therapy to assist with recovery. Andy and his wife are concerned about him not being able to drive.

Questions / Learning 

What teaching information should be provided to Andy and his wife at this stage? a. Re-enforce information given in ED b. Confirm diagnosis c. Review importance of calling 911 if new signs of stroke d. Review risk factors for stroke and confirm which apply to Andy e. Medication teaching and management f. Expectations for recovery g. Expectations for return to work h. Criteria for driving again i. Review purpose of further testing

Questions / Learning 

As a Healthcare provider, what tools and processes support Andy’s transition back to the community? a. Early completion of stroke specialists letter back to PCN physician b. Written information regarding follow up appointments c. Advise who will take over care d. Refer to local rehab department e. Advise re local stroke support groups

3rd Medical visit Transition

 Andy was seen by his family physician within 1 week of the SPC consult. His doctor reviewed recent fasting bloodwork and his blood pressure readings since the SPC clinic visit. Andy was known to have mild hypertension for a number of years, but was reluctant to take medications. Most of the recorded BP readings this week were greater than 155 systolic and greater than 100 diastolic. Andy was advised that he needed to be on medication to control this risk for stroke. As well, his fasting lipids were elevated. His Holter monitor results were not available at this appointment. Andy told his physician that he had an appointment with the OT at the Healthcare Centre that same afternoon.

Questions / Learning 

What teaching information should be reviewed at this time? a. Provide information regarding hypertension and management b. Review information regarding lipid management c. Provide information regarding CDM education and self-management programs in community d. Discuss goal setting as a strategy to make changes in lifestyle e. Support patient centered goal setting f. Discuss follow-up g. Complete depression screen as necessary Define Collaborative Care Planning and goal setting:¬¬________

4th Medical visit Transition

 Andy was assessed by an Occupational Therapist with training in visual rehabilitation. During therapy, she was able to determine the impact of Andy’s visual deficits on his finances, emotions and relationships. She was also able to identify potential safety concerns that would have to be addressed as he returned to a new normal in life.

Questions / Learning 

Define the term “Community Re-integration”:_______________ What actions can this OT take to support Andy’s return to meaningful activities of daily living? a. Screen for other deficits that may not have been initially identified ie cognitive assessments b. Do a home visit to assess for potential safety concerns c. Provide information regarding alternate transportation options d. Re-enforce information regarding local community services e. Assess for potential to return to work

NEW !! New & Improved . . .

Latest Build . . .

Interactive Conversations

 I think another approach might be an interactive conversation.

See some of the examples on this link.

http://www.jellyvision.com/work/

Interactive ComicTheme

Initial Mockups

Proposed Template Style

This is Cathy Moore's work below. She is a internationally renowned Elearning guru. I like the simplicity, the interactivity and the ebb and flow of this style. I think we could fit our scenarios into this style to give us some strong learning experiences for our learners.

Here are a few other examples from other authors.

http://blogs.articulate.com/rapid-elearning/comic-book-elearning-examples/