329 - Improving Patient Safety Through Simulation: Prone Position
Description: Description of team The professional development educators at a community hospital implement mandatory resuscitation education yearly for the procedural staff including nurses, surgical technologists, anesthesia technologists, and patient care technicians. Assessment When looking at the yearly needs assessment many staff had questions about emergencies occurring in the prone position. Upon further investigation, data revealed that operating room cases in the prone position doubled from the previous fiscal year. There were also incident reports of cardiac arrests that occurred while patients were in the prone position. Factors were clear that education for Operating Room staff had to occur for patients in the prone position in order to promote staff knowledge and patient safety. The needs assessment also revealed that the preferred methodology of education for Operating Room Staff was simulation. Preparation and planning/Implementation The perioperative educators created mandatory simulation sessions for all of the Operating Room staff to attend. There was a standard actor who simulated the anesthesiologist in order to promote fidelity to the procedural staff. An evidenced based simulation case scenario of a patient intubated in the prone position prepped and draped before surgery was created. The procedural staff were relieving the night shift. After the staff assumed responsibility the patient went in to cardiac arrest.
Objectives: 1. The learner will demonstrate effective management of an intraoperative VF cardiac arrest of a patient in the prone position. 2. The learner will apply AHA/BLS guidelines of a patient with an advanced airway. 3. The learner will demonstrate effective nontechnical skills through professional interdisciplinary communication and role identification. 4. Apply safety and communication recommended practices The simulation scenario lasted between 6-8 minutes. After each simulation an in depth debriefing occurred. Outcomes: The level of knowledge for cardiac arrest in prone position from the OR team increased from 38% to 68%Staff were appreciative of hands on practice with prone positionStaff expressed gratitude to complexed fidelity in the Operating RoomStaff were thankful for practice with advanced airway 41% of staff were unaware of continuous compressions and breaths every 6-8 seconds with an advanced airway in placeCompression depth from staff was only 1.5 inches Implications for perioperative nursing The simulation allowed perioperative staff to get hands on practice with prone position. It also enables them to identify standards and resources for positioning during code blue situations. Implementing mandatory resuscitation scenarios into the perioperative setting is a way for staff to get hands on education with different scenarios and implement best practices into their daily work in order to improve patient safety.