The purpose of this simulation is for students to gain experience with conducting an Annual Wellness Visit (AWV). Conducting the AWV is an important nursing role in many ambulatory care setting, and one with which nurses are often unfamiliar. Starting in 2011, Medicare began coverage of annual wellness visits for Medicare beneficiaries. The purpose of this visit is to check for any changes in health information, perform a health risk assessment, and develop or update a personalized prevention plan. The AWV is not the same as an annual physical, and physical examination (except for vital signs, height, and weight) is not normally done (and is not reimbursed as part of the visit).
Learning Objectives
By the end of this simulation-based experience, the learner will be able to…
- Understand the purpose of an Annual Wellness Visit (AWV) and what assessments are obtained.
- Describe the RN’s roles and responsibilities in managing AWVs and how this represents top-of-scope practice.
- Use patient-centered care strategies and communication to establish rapport, answer questions, and collect assessment data during an AWV.
- Collect appropriate AWV assessments using common guidelines for these visits.
- Practice collaboratively with other health care workers to follow-up on relevant AWV assessment findings.
Expectations
Learners are expected to arrive in professional attire (as per course/Simulation Center policy) at the in-person or online synchronous simulation session having (1) fully reviewed this student guide, (2) completed the assigned readings and videos, and (3) completed the application questions. All students are expected to have fully reviewed the assignments below, particularly the Annual Wellness Visit Toolkit for Students. Students are also expected to have the Observer Form to complete should they be assigned that role, and to adhere to the Simulation Agreement.
The simulation session will begin with a prebriefing, during which the facilitator will take attendance, assign roles, review expectations, review the learning objectives and reflection questions, and read the learner brief to begin the scenario.
In this simulation scenario, you will meet Charlie Plummer, a 78 year old man, for his annual wellness visit. He received notification of the visit by mail, along with the Health Risk Assessment (HRA) to complete. You will collect and analyze the HRA and will collect additional assessments, using the Annual Wellness Visit Checklist as a guide. We will then pause the scenario and have a quick debrief as a group. In this debrief, we will prioritize findings and strategize interventions. In the second part of the simulation scenario, you will provide teaching, collaborate with the patient on a plan of care, provide referrals, and review a schedule for recommended preventive services. The scenario will be followed by a longer debriefing session, in which the facilitator will guide the learners through reflective examination of the events and decisions that occurred during the scenario.
The prebriefing, scenario, and debriefing will take about 80-90 minutes.
Topics
- Medicare Annual Wellness Visits
- Health and aging
- Screening and prevention
- Fall risk
- Depression
- Home safety
- Collaborative care planning
Preparation (Readings and Videos)
To be prepared to participate effectively in this simulation-based learning experience, students must have the following knowledge. It is important that every student arrives fully prepared so you can participate to the greatest extent that you are able, and so this is a good learning experience for you and your colleagues.
For this simulation, you will need to be generally familiar with the purpose of an Annual Wellness Visit, and what assessments are obtained.
Required preparation:
- Orange County Healthy Aging Initiative. (2017). Annual wellness visit toolkit video for Orange County [YouTube]. Retrieved August 25, 2020 from https://www.youtube.com/watch?v=i46mWOpFmEI. This is a very good overview video showing how one organization (OSHAI) implements AWVs. You will be using forms from the toolkit during the simulation. These forms are linked below for you to review before the simulation. Some notes on the video – it is not entirely clear about who is doing the assessment (because she doesn’t introduce herself, which she should do), but it seems to be a nurse. The physician (geriatrician) discusses the findings with the patient in the video, most of which could be done by the nurse (being careful to stay within your scope of practice). Even when the nurse conducts most of the visit, a provider (physician, nurse practitioner, physician assistant, etc.) reviews the assessment and speaks briefly with the patient at the end of the visit.
- Download the Annual Wellness Visit Toolkit for Students. Read this document thoroughly. You will be following the AWV Checklist during the simulation and reviewing/administering the assessments that are included. The Health Risk Questionnaire in your toolkit (pp. 6-11) includes responses from your simulated patient. Be sure to review this form and consider your priorities. During the simulation, you will review the HRA with the patient, as well as collecting the other assessment data detailed in the AWV checklist.
Recommended resources:
- Healthwise Staff. (August 22, 2019). Your Medicare yearly wellness visit. Kaiser Permanente. Retrieved from https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.your-medicare-yearly-wellness-visit.abr7782
- Annual wellness visit. (August, 2018). Centers for Medicare and Medicaid Services. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf. Read pp. 1-8. The simulation will use the “Subsequent AWV Components” (pp. 7-8). Pages 9-16 cover billing and advanced care planning. If you plan to print the document, you might prefer to use the printer-friendly version, which is formatted as text-only.
Pre-Simulation Application Questions
- What is the purpose of the Annual Wellness Visit? How does it differ from the annual physical examination? How would you explain the purpose of the AWV to a patient?
- What are the nurse’s roles and responsibilities in the AWV? What would be outside the RN scope of practice?
- How can the AWV benefit the patient and improve their health status?
- What would you want to follow up on with the patient after an AWV? What would be some efficient ways to provide this follow up in the ambulatory care setting?
- What health care team members might be involved with the AWV and follow-up? How can responsibilities be coordinated between these team members?
- After reviewing the AWV forms, do you have any questions?
Observer Form
Learners who are not active participants in the scenario are expected to complete an Observer Form. Observers’ insights offer key learning opportunities during debriefing. Have this form ready to fill out during the scenario.
Simulation Agreement
I understand and agree to the following responsibilities for making simulation a valuable learning experience for all students. I agree to honor the following principles:
Fiction Contract
- I will treat the simulation as if it were a real clinical situation to the greatest extent that I can.
Professionalism
- I will complete preparatory assignments so I am ready to fully participate in the simulation experience and to support effective learning for the whole group,
Confidentiality
- Maintain confidentiality of debriefing discussions and students’ performance in the simulation scenarios to support a safe and collegial learning environment; and
- Keep the content of this simulation activity confidential to avoid spoiling the experience for those who have not yet participated.
Respect
- I will offer comments to colleagues in a respectful and sensitive manner and will be respectful to persons with varied viewpoints, including those with whom I do not agree; and
- Appreciate the contributions of diversity to varied student and patient perspectives, seeking understanding, equity, and inclusion.
Acknowledgements
This content is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $2,090,495 with 0 percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.
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