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A Quality Improvement Project Using Simulation To Improve Nursing Confidence And Skills And Promote Teamwork During High Acuity, Low Occurrence Clinical Events In The Pediatric Intensive Care Unit
Kimberly Torrey-White1, Laura Gary1, Amber Bergson1, Jennette Flynn1, Mindi Driehorst1, Russ Siekman1, Frances Prekker1, *Tina Slusher1, Kelly Maynard1, Glenn Paetow1, V.N. Vimal Rao2, Lori Hendrickx3, *Ashley Bjorklund1
1Hennepin County Medical Center, Minneapolis, MN;2University of Minnesota, Minneapolis, MN;3South Dakota State University, Brookings, SD

Purpose: A PICU quality improvement project was initiated to improve interdisciplinary teamwork and promote nursesí knowledge and confidence in high acuity, low occurrence clinical events. Relevance/Significance: PICU nurses are often first to observe clinical decline in their patients. Resuscitation events are relatively uncommon in the PICU, contributing to decline in skills and knowledge. Low patient volumes during the COVID-19 pandemic have exacerbated this problem, creating a sense of urgency about maintaining critical teamwork and resuscitation skills. Strategy and Implementation: The Model for Improvement and Plan-Do-Study-Act methods were used to develop two multidisciplinary in situ simulations and two nurse education activities. Simulation 1 involved a traumatic brain injury patient experiencing acute deterioration requiring intubation and extra-ventricular drain placement. Simulation 2 involved the same patient subsequently developing increased intracranial pressures. Debriefings following each simulation were led by the PICU medical director. Nurse education activities reinforced concepts, including extra-ventricular drain set-up and an error identification exercise. Evaluation/Outcomes: For each simulation nurses completed pre and post self-confidence scales (n=27). Participants from all disciplines completed a teamwork survey (n=37). Nurse confidence regarding management of clinical deterioration in PICU patients improved post-simulation (p<0.001), with average confidence ratings improving from 38.11 to 41.33 (out of 45). Teamwork ratings improved between Simulations 1 and 2 (p = 0.003), with median ratings improving 24.7%, from 1.375 to 1.714, out of 2. Implications for Practice: Multidisciplinary simulations and related learning activities can be an effective way to promote teamwork, PICU nursing skills, and confidence during periods of reduced patient volumes.


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