# Trend Method — v1

**Audience:** Unit leadership, CCO
**Status:** Review draft; pending Nexus / CPI / risk / legal validation

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## 1. What We Are Trending

The proctor sheet captures four yes/no checks per sim, the sim ID, and staff participant names for attendance and trend review. It does not capture patient names or PHI. The trend method turns those rows into a signal the CCO can read at a glance.

This is a trend method, not an outcome study. It shows whether the unit is running the sims, whether the loop is being followed, and where the judgment gaps are clustering. It does not, on its own, prove that running sims reduces restraint, seclusion, or injury.

## 2. The Two Charts

### Chart 1 — Sim Cadence and Loop Fidelity

A run chart with two lines:

- **Sims per week** (count of proctor rows per week)
- **Loop fidelity** (% of proctor rows where all four Y/N checks are "Y")

The CCO reads this chart for two questions: Are we running the sims, and are we following the loop?

Signal rules:

- Fewer than two sims in a week, two weeks in a row: cadence has slipped. The charge nurse and unit educator name the cause.
- Loop fidelity below 80% for two weeks in a row: the proctor needs a refresher on the five-minute loop.

### Chart 2 — Judgment Gap Map

A simple tally of which sims most often get a "N" on the threshold-named check or generate a "no" or "not sure" on the judgment question. Displayed as a ranked list, refreshed monthly.

The CCO reads this for: Where is the team least certain?

Signal rules:

- Any sim in the top three of the gap map for two months in a row: review the sim wording with the unit educator. The sim may be unclear, or the underlying judgment point may need a teaching moment outside the sim.
- A new sim appearing in the top three within its first month: the team is learning it. No action needed unless it persists.

## 3. The Rollup

A monthly one-page rollup has four blocks:

1. Sims run this month (count and trend).
2. Loop fidelity this month (percent and trend).
3. Top three judgment gaps (ranked list).
4. One observation from the unit educator in plain language.

No tables longer than one page. No charts that require a statistician to read. The CCO reads it in two minutes.

## 4. What This Method Does Not Do

- It does not measure patient outcomes directly.
- It does not replace the existing restraint, seclusion, injury, or readmission measures.
- It does not attribute any change in patient outcomes to the sims.
- It does not generate a competency decision for any staff member.

## 5. What Counts as a Signal Worth Acting On

- A sim that has saturated (every team member answers the judgment question correctly for a month): retire or refresh the sim.
- A sim that consistently produces a "N" on threshold-named: review the proctor script and the sim wording.
- A unit that stops running sims for more than two weeks: the cadence has slipped. The CCO names it at the next monthly review.

## 6. Validation Boundaries

This trend method is a frontline signal. It is not a clinical-quality measure reported to the board until validated by the CCO, quality, and compliance. Patient-outcome attribution is out of scope for this method.