Oral Themed Presentation
Background: : Safe and effective delivery of pediatric anesthesia requires an interprofessional team approach. At our tertiary pediatric academic hospital, the team consists of anesthesiologists and nurses in the Operating Room (OR), Post Anesthetic Care Units (PACU) and satellite locations as children require anesthetics to tolerate a variety of procedures conducted at multiple locations. There is a large range of learning needs amongst perioperative nurses due to the variations in cases and experiences, with inconsistent opportunities for exposure and real-life practice of the management of critical events. Simulation-based education is highly accepted and effective for the practice of the knowledge and skills in the management of medical crises. In-situ simulation conducted in our work environments promotes realism and allows for interaction with our usual equipment and supplies.
Research Question: : The aim of this pilot project is to determine if an anesthesia-led, in-situ simulation session will provide a forum for education and exchange of knowledge and information for management of a common pediatric anesthetic critical event.
Methodology: : Staff nurses from the OR, PACU and a satellite unit were divided into small groups for classroom discussions on laryngospasm followed by in-situ simulation with debriefing. The hour-long sessions were led by anesthesia fellows and the interprofessional education specialists. Pre-session and post-session evaluations were completed by nurses for self-assessment on knowledge and abilities. Semi-structured interviews were conducted with facilitators to determine benefits, logistics and barriers. Latent safety threats were tracked and corrected.
Results: : 50 nurses (36 OR, 11 PACU, 3 satellite) participated with 100% response rate for completion of evaluations. There was a significant increase in the self-rated knowledge of the risk factors (χ2 = 89.5, dof = 4, p < 0.005), principles of management of laryngospasm (χ2 = 74.6, dof = 4, p < 0.005), technical skills in assisting in the management of this disease entity (χ2 = 34.3, dof = 4, p < 0.005), and accessing supplies and drugs in our work environment (χ2 = 43.6, dof = 4, p < 0.005).
There was a high level of satisfaction and engagement by participants and facilitators who also noted gains in camaraderie, understanding of roles and logistics in critical event management. The posted guide for obtaining medications in PACU was noted to be out of date. Barriers to retrieval of supplies and medications from the relatively new dispensing units were identified and corrected.
Discussion/Conclusions: : Small group, relatively short simulation for perioperative nurses by anesthesia fellows provided a safe and highly-engaging forum with mutual benefit in the exchange of knowledge with gains in teamwork skills. In-situ simulation allowed for practice and understanding of logistics and barriers in access of supplies and medications. Future plans include expansion to include participants from other satellite anesthesia locations and development of a simulation-based education curriculum for pediatric perioperative nurses.