356 - ECPR SIMULATION: Practicing Expectations Prior to Emergency Situations
Clinical Issue: Extracorporeal Cardiopulmonary Resuscitation (ECPR) events typically occur as unplanned emergency events creating a gap in the ability of cardiac surgery nursing staff to be able to adequately train prior to being on emergency stand by call. Description of Team: Planning Team: Simulation Medical Director, Simulation Education Specialists, Simulation Technologists, Cardiac Nursing Director, Extracorporeal Membrane Oxygenation (ECMO) Nursing Directors, and Cardiac Surgery Nursing Staff. Participants: Simulation Education Specialist, Cardiac Surgeon, Cardiac Anesthesia, Cardiac Nursing Team, ECMO Core Team, Perfusionist, Intensivist, Pharmacist, Respiratory Therapist, and Pediatric Intensive Care Unit (PICU) Nursing Staff Preparation and planning: The simulation education specialists along with specific team members, developed a realistic Extracorporeal Cardiopulmonary Resuscitation (ECPR) experience. The team designed a scenario to expose the learner to problem solving, critical thinking and communication skills. The planning team developed learning objectives to encompass closed loop crisis communication, systematic cannulation in a high stressed environment and transformation of PICU room to Operating Room environment.
Assessment: ECPR is a high risk, low volume procedure. Cardiac nursing leadership and staff identified a gap regarding the skills and confidence needed to assist with ECPR set-up and cannulation outside of the operating room. A facilitator conducted a multi-disciplinary debriefing immediately following the simulation learning event. A self-efficacy evaluation was also completed by participants at the conclusion of the learning event. Implementation: The experience consisted of, but not limited to, responding to the activation of ECPR through the paging system, gathering of needed equipment, supplies and instruments, preparing the room and patient for ECPR, scrubbing, gowning and gloving, table set-up, instrument passing, position and prepping of patient, and achieving neck cannulation while a resuscitation was being performed. Outcome: Simulation planning team implemented a high fidelity unannounced multi-disciplinary in situ ECPR simulation in the intensive care setting. Participants reported increased confidence when responding to an ECPR event and found the learning valuable to clinical practice. Implications for perioperative nursing: Simulation is quickly becoming the gold standard for medical training and ongoing competency. Cardiac Surgery nurses at our institution have not historically participated in clinical simulations. This project highlighted the need for on-going simulation for Cardiac Surgery Operating Room staff in high risk, low-volume emergency scenarios.
Co-Authors: Eric Gosche, Barbara Mueller, James O Brien, Haley Borchers, Debra Newton, Kari Davidson, Jamie Parson, Rachael Pedigo, Robert Schremmer, William Gibson, Talya Frey, Justin Pannullo, Richard McComas, Kellen Goldberg