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CS382
Maintaining Competency in Cardiovascular Surgery Using High-Fidelity Simulation
By: M. Maxwell, & A. Kreeger; Exempla Good Samaritan Medical Center, Lafayette, CO.
For further information, please contact: maxwellm@exempla.org
Purpose: To increase skills and competency when caring for cardiovascular surgery patients during the immediate post-operative phase.
Description: In May of 2007, EGSMC opened a cardiovascular surgery program. During the program ramp-up phase, a core group of ICU staff were trained; all have previous CV surgery experience. The initial training included skills competency check-off and day-in-the-life scenarios. At the conclusion of these events, staff requested a more “real life” training process. Using high fidelity simulation, we were able to simulate a patient admitted direct from surgery following coronary artery bypass grafting. This patient soon became hemodynamically unstable due to thoracic bleeding. With the high-fidelity simulator, we were able to simulate an increase in thoracic bleeding from the chest tubes; as well as all the hemodynamic consequences that would arise with the thoracic bleeding, i.e. low B/P and cardiac output. Each simulation group paired two nurses from the ICU CV team and the scenario ran for approximately 45-60 minutes. In the pre-brief, nurses were instructed to care for this simulated patient just like a real patient, including drawing blood for labs, giving medications or blood products, calling the physician, interacting with the family and all of the required documentation.
Evaluation and Outcomes: Staff were initially apprehensive, however once the scenario began all participants became engaged in the event and the patient “came to life.” Debrief sessions were held with each scenario. Any identified issues became teaching and learning opportunities. In conclusion, staff demonstrated competency with CV skills, greater critical thinking capability and in doing so stated that they felt more confident in caring for CV surgery patients.
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