Scholarly ProjectSTEPHANIE MONROEFERRIS STATE UNIVERSITY

Presentation Objectives

Define purpose of scholarly project State project goal and objectives Describe personal and professional accountability Analyze project outcomes Provide summary of evaluations State recommendations for similar projects

Project Description

To develop, implement, and evaluate a clinical simulation for the cardiothoracic unit nursing staff at Munson Medical Center

Project Goal and Objectives

Goal: A2 nurses will improve their documentation of procedures using sedation and cardiac rhythm strips after completion of the simulation

Objectives: Demonstrate proper set up of a room for a cardioversion per a2 protocol Demonstrate competency in documenting a procedure requiring sedation per MMC

standards Describe proper documentation of cardiac rhythm strips per A2 protocol Demonstrate competency in the use of a biphasic defibrillator including application Apply Teamwork principles to performance of BCLS/ACLS algorithms

Pre-simulation Audits of Documentation of Procedural Sedation on A2

Procedure 

 

Documented under

procedure/treatments in I -

View

Documented in a focus note

  

Mentioned in shift summary

Vital signs documented

Strips posted if DCCV

Chest tube insertion

    X    

Chest tube insertion

  X      

Chest Tube insertion

  X      

DCCV   X     XDCCV   X   X  DCCV   X      DCCV   X   X  DCCV   X

(from RT)    X

DCCV X X X X(no resp.)

X

DCCV   X   X XDCCV   X   X XDCCV   X   X

(1 set) 

Central line insertion

  X   X(BP & HR only)

 

Total 1% 92% 15% 53% 56%

Pre-simulation Audits of Procedural Sedation Documentation on A2

Procedure Sedation Medication Patient's Tolerence Vital Signs Aldrete Score012345678

Documentation Audit of DCCVs on A2

DCCV

Occ

urre

cne

in D

oc-

umen

tion

out

of 9

D

CCVs

Project Outcomes

At completion of the clinical simulation the cardiothoracic nurses were able to: Demonstrate proper set-up of a room for a cardioversion per A2 unit

standards Demonstrate competency in documenting a procedure requiring sedation

per Munson Medical Center’s standards of care Describe proper documentation of cardiac rhythm strips per A2 unit

standards Demonstrate competency in the use of a biphasic defibrillator including

application Apply teamwork principles to performance of BLS/ACLS algorithms

Post-Simulation Audit of Procedural Sedation Documentation

Proced

ure/Tr

eatm

ent F

lowshe

et Used

Aldrete

Score

Used

Vital Si

gns D

ocumen

ted

Patie

nt To

leren

ce Docu

mented

Seda

tion M

edica

tion U

sed 0%

40%

80%

120% 100% 100% 100% 100% 100%100% 100% 100% 100% 100%100%

0%

100% 100% 100%

Procedural Sedation Documentation

Chest tube Placement DCCV Reintubation

Required Components To Documenting Procedural Sedation

Perc

ent T

hat D

ocum

enta

tion

Occu

rred

Analysis of Outcomes:Adherence to Legal and Ethical Standards

Autonomy: Utilization of pre-procedure checklist ensures patient has given informed consent

Beneficence & Nonmaleficence: Being compliant to policies and standards of care we ensure quality care and protect patients from harm

Fidelity: compliance to the hospital policies and standards of care demonstrate commitment to safe and quality care

Justice: All patients on the cardiothoracic unit will receive a level of care that is in compliance with hospital policies and standards of care

(ANA, 2011)

Analysis of Outcomes:Adherence to Organizational Standards

Congratulations A2 staff! In post-simulation chart audits of documentation of procedural sedation the staff was found to be nearly 100% complaint to the hospitals policies and standards of care.

Analysis of Outcomes:Adherence to Nursing Standards

As a future nurse educator it is my responsibility to be in compliance with the National League for Nursing’s [NLN] (2005) Core Competencies of Nurse Educators: Facilitate Learning Facilitate Learner Development and Socialization Use Assessment and Evaluation Strategies Participate in Curriculum Design and Evaluation of Program Outcomes Function as a Change Agent and Leader Pursue Continuous Quality Improvement in the Nurse Educator Role Engage in Scholarship Function within the Educational Environment (NLN, 2005)

Personal and Professional Accountability

Project was implemented in an organized way I completed all project tasks within the agreed timeframe I provided excellent communication to all individuals involved A2 staff was provided with all necessary materials needed to

successfully complete the simulation I have served as a valuable resource to staff on all aspects related to

the project

Evaluation of ProjectAt the end of this program, I was able to:

Strongly Agree

Agree Neutral Disagree Strongly Disagree

1. Demonstrate proper set-up of a room for a cardioversion per A2 protocol.

90% 10%      

1. Demonstrate competency in documenting a procedure requiring sedation per MMC standards.

97% 3%      

1. Describe proper documentation of cardiac rhythm strips per A2 protocol.

93% 7%      

1. Demonstrate competency in the use of a biphasic defibrillator including application.

90% 10%      

1. Apply teamwork principles to performance of BCLS/ACLS algorithms.

93% 7%      

 I clearly understood the purpose and objectives for the simulation.

93% 7%      

The scenario resembled a real-life situation. 90% 10%      Did the scenario allow you to use your critical thinking and decision making skills?

93% 7%      

The simulation provided a variety of ways in which to learn the material.

87% 13%      

The materials provided to review before the simulation were valuable.

93% 7%      

The debriefing session was well-organized. 93% 7%      The facilitator, Stephanie Monroe demonstrated expertise in the content area.

93% 7%      

Feedback provided during the debriefing was constructive. 90% 10%      The simulation activity reinforced my knowledge base. 93% 7%      After participating in the simulation activity, do you feel more confident in a similar situation in the clinical environment?

90% 10%      

Evaluation of Project

Q: What did you find most helpful about the simulation?A: The education related to procedural sedation was most helpful

Q: What would you like to seen done differently in the future? A: Incorporate open chest at the bedside and sterile procedures

Q: How will you apply the information learned in clinical practice?A: I will now utilize the proper form to document procedural sedation

Recommendations for Future Simulations

Offer a variety of opportunities to complete simulation Assign roles to participants and ensure understanding of role Allow enough time for participants to switch roles and repeat the

simulation Start simulation planning early

Summary

Simulation has been proven to be an effective learning tool for the staff on A2

Pre-simulation audits identified a learning gap in procedural sedation documentation

Post-simulation audits found A2 staff to be nearly 100% compliant with hospital policies and standards of care

In the future staff would like to see open chest at the bedside incorporated into simulation

References

American Nurses Association (2011). Short definitions of ethical principles and theories familiar words, what do they mean? Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-Definitions.pdf

National League for Nursing (2005). Core competencies of nurse educators with task statements. Retrieved from http://www.nln.org/profdev/corecompetencies.pdf