Traditional Poster Round
Background: : Simulation-based mastery learning (SBML) is a rigorous form of competency-based education where skills are measured against a mastery level or minimum passing score (MPS). Outcomes are uniform and training time varies . SBML in central venous line (CVL) insertion and maintenance bundles has led to increased compliance rates and decreased infections [1, 2, 3]. SBML has also been widely applied in medical curriculum; however it has been underutilized in nursing curriculum. Central line-associated bloodstream infections, are associated with increased morbidity and mortality as well as increased cost . This study investigated the use of SBML for central line cap change procedure with pediatric hematology oncology nurses.
Research Question: : What is the effect of SBML on the current compliance for central line cap changes for nurses on the hematology/oncology unit?
Hypothesis: Compliance with central line cap change procedure with hematology/oncology nurses will increase after SBML intervention.
Methodology: : A pretest-posttest, quasi experimental design (n= 80). Pretest assessment conducted to determine ability to perform a central line cap change procedure. Nurses participated in deliberate practice until they were able to reach mastery in the posttest. The posttest was conducted on a separate day from deliberate practice. After meeting mastery, participants completed a post-questionnaire. Descriptive and comparative analysis was conducted. ANOVA was utilized to compare participant performances from different demographic backgrounds (e.g. years of experience, frequency of procedure).
Results: : 77 participants (n=3 lost to follow up due to job change) completed the study with ultimate mastery attainment. 31% (n=24) of participants achieved mastery in the pretest. 72% (n=38) of the remaining nurses achieved mastery in the second attempt. 100% (n=15) of the remaining nurses achieved mastery in the third attempt. Higher years of experience as a registered nurse did not correlate with pretest scores. More years as a hematology oncology nurse, a role that requires extensive central line maintenance cares, was also not correlated with scores. The most commonly missed step was maintaining sterile protocol, 60% of nurses missed this step on the pretest.
Discussion/Conclusions: : SBML was utilized to achieve mastery in 100% of the hematology oncology inpatient nurses. Only 31% of participants were able to meet mastery in the pretest, indicating exposure to the procedure in clinical setting is not sufficient to maintain mastery of this high risk skill. No correlation was found with the amount of cap changes the participant conducted in practice and their ability to perform the skill. No correlation was found with years of experience as a RN or hematology oncology experience and ability to perform the skill. This illustrates the challenge in nursing continuing education and encourages further understanding about skill drift. This data may indicate the need for refresher education for all nurses and not just focus on specific groups. This study demonstrates that current practice of central line cap changes is often not compliant with institutional policy and SBML is an appropriate method to improve compliance.