251 - Operating Room (OR) Orientation: Bridging the Gap from Classroom to OR with Simulation
Clinical Issue: An academic medical center, which includes seven hospitals, had an established surgical services orientation class. The third day of this class included both lecture in a classroom and hands on skills and simulation for nurses, surgical technologists and other intraoperative staff. Previous class participants provided feedback that more hands on time would increase staff knowledge, skills, and confidence when entering a real operating room (OR). Therefore, the surgical services nurse educator requested simulation scenario development. Description of Team: The team included a simulation lab education facilitator and the nurse educator for surgical services. Preparation & Planning: The third day of the surgical services orientation class was already taking place at the center for simulation, but scenarios were not part of the curriculum. The team revised the class to include both skills and simulation scenarios. New and specific learning objectives were established early in the planning process. After that, the facilitator and the educator developed, edited, and tested the simulation scenarios. A practice run of the scenarios took place before implementation.
Assessment: A pre and post evaluation was used as an assessment tool. The learners were asked to assess the change in their knowledge and skill level. The learners rated their level of confidence for each learning objective using a 5-point Likert scale, ranging from “Very Low” (score of 1) to “Very High” (score of 5). Implementation: The first few hours of class consists of practicing skills such as preoperative patient interview, scrubbing, gowning, gloving, sterile table set up, instrument identification, and counting. In the afternoon, learners participate in two laparoscopic scenarios. The scenario begins with setting up the OR and ends with Time Out #2.Over the course of one year, 74 learners have participated in the orientation simulations. Outcome: Data analysis was performed on the self-evaluations using a paired sample t-test. All evaluation scores were statistically significant with a p-value less than 0.001. Learning Objectives with pre-evaluation score and post-evaluation score: Perform preoperative patient interview Score increased from 2.86 to 4.47 Perform surgical scrub Score increased from 2.92 to 4.26 Demonstrate sterile technique through table set up and patient draping Score increased from 3.19 to 4.13 Understand location and operation of basic OR equipment Score increased from 2.77 to 4.19 Perform surgical counts and time out within hospital policy Score increased from 2.89 to 4.26 Implications for Perioperative Nursing: Operating Room orientation programs are an important factor in nurse retention.Skills laboratories and simulation scenarios should be built into these programs.Simulation education is one method that can be used to increase the knowledge, skills, and confidence of perioperative staff.