302 - Utilization of Simulation-based Training and Task Cards to Improve Intraoperative Pediatric Massive Transfusion Protocol
Description: Clinical Issue Massive transfusions (MT) occur in 3% of patients and is associated with poor patient outcomes. Given that MT events are rare in pediatrics, massive transfusion protocol (MTP) implementation is often disorganized and uncoordinated due to lack of staff knowledge and experience in relation to acute hemorrhagic resuscitation. Description of Team A group of nurses at the Children’s Hospital of Georgia (CHOG) formed a team that will address the need for a performance improvement (PI) that could improve MTP implementation within the intraoperative setting. Preparation and Planning Design a pre and a post test that will gauge staff’s knowledge of MTP basics. Design a tool that will evaluate the confidence level of staff in an MTP event. Create task cards that will be used during the simulation-based training. Create a patient scenario that will be used for the SBT. Create a power point presentation to discuss the main points of the MTP. Learn how to set-up the rapid infusing device. The training will take about 1.5 hours which will include administration of four tests/evaluations, SBT, debriefing, a power point presentation, demonstration of rapid infuser set-up, and question and answer portion. Assessment The group identified the following problems with the implementation of pediatric MTP intraoperatively: a) delayed recognition of the need for MTP activation, b) disorganized implementation of MTP, c) unclear roles of interdisciplinary team members during MTP event, and d) unfamiliarity of staff to rapid infusing devices. Implementation The PI project was implemented on September 23, 2019. Twenty-one intraoperative staff members were present. After welcoming the team members who are in attendance, a pretest and pre-evaluation were handed out. The staff was asked to complete the pre-evaluation form before the simulation-based training. After the SBT and the debriefing were completed, the staff was then asked to complete the post-evaluation form and the post test. The PI project would like to evaluate the staff’s knowledge on the basics of MTP and the staff’s confidence level towards MTP cases. Outcome The average percentage of the pretest scores is 66%. The average percentage of the post test scores is 91%. The PI project increased the test scores by 25%. Additionally, it was noted that there was a significant increase in confidence level in responding to an MTP event after the PI project was implemented. Implications in Perioperative Nursing The utilization of SBT and task cards were effective in improving staff knowledge of the MTP and staff’s confidence in responding to MTP events. Since MT is effective when implemented by a provider accustomed with the protocol, it is concluded that healthcare outcomes of pediatric patients who receive MT will improve consequently.