From the Center for Simulation, Advanced Education and Innovation (A.K.S., A.M.M., A.N., V.M.N., E.L.), and Department of Nursing (A.K.S., A.M.M., A.N., V.M.N., E.L.), and Department of Anesthesiology and Critical Care Medicine (A.N., V.M.N.), The Children's Hospital of Philadelphia, Philadelphia, PA.
Simul Healthc. 2013 Oct;8(5):341-9. doi: 10.1097/SIH.0b013e3182974462.
Central line-associated blood stream infection (CLABSI) is a preventable burden to our current health care system. Inconsistencies in knowledge and practice of central venous catheters (CVC) dressing change procedures are associated with CLABSI. We hypothesized that participation in a "just-in-time" and "just-in-place" CVC dressing change program would improve nurses' knowledge, confidence, and psychomotor performance on mannequins (eg, T1 outcomes). Moreover, this simulation program would be associated with improved procedural competence on real patients (T2 outcomes) and hospital CLABSI rate (T3 outcomes).
We conducted a prospective before and after timed series study at a large urban children's hospital. This program provided an opportunity to practice a CVC dressing change using a simulated patient chest/arm. Cognitive and psychomotor skills were evaluated using a pre-self-assessment/post-self-assessment, written knowledge test and direct observation using a standardized checklist. Central line-associated blood stream infection rates were monitored monthly by the Office of Quality and Patient Safety.
Five hundred twenty-four inpatient nurses participated in this program between November 2008 and May 2010. Knowledge and self-confidence improved significantly (knowledge, 4.1 [0.7] vs. 4.6 [0.5], P < 0.001; self-confidence, 4.1 [0.8] vs. 4.6 [0.6], P < 0.001). Of 2469 real-patient CVC dressing changes observed, dress rehearsal trainees required fewer corrective prompts (9% vs. 21%, P < 0.001), and CLABSI rates decreased from 5.3/1000 to 2.9/1000 line days (P < 0.001) during the study.
This program improved nurse's knowledge, self-confidence, and psychomotor skill performance on mannequins (eg, T1 outcomes). These improvements were associated with improved procedural competence on real patients (T2 outcomes) and a temporal association with decreased hospital CLABSI rates (T3 outcomes).
中心静脉导管相关血流感染（CLABSI）是当前医疗体系的一个负担。在中心静脉导管（CVC）更换敷料的过程中，由于知识和实践的不一致，会导致 CLABSI 的发生。我们假设，参与“即时”和“即时”的 CVC 更换敷料程序将提高护士在人体模型上的知识、信心和运动技能表现（例如，T1 结果）。此外，该模拟计划与在实际患者中提高程序能力（T2 结果）和医院 CLABSI 率（T3 结果）相关。
我们在一家大型城市儿童医院进行了一项前瞻性的前后时间序列研究。该计划提供了一个使用模拟患者胸部/手臂进行 CVC 更换敷料的实践机会。使用预自我评估/后自我评估、书面知识测试和使用标准化检查表进行直接观察，评估认知和运动技能。质量和患者安全办公室每月监测中心静脉相关血流感染率。
2008 年 11 月至 2010 年 5 月，524 名住院护士参加了该计划。知识和自我信心显著提高（知识，4.1 [0.7] 与 4.6 [0.5]，P <0.001；自我信心，4.1 [0.8] 与 4.6 [0.6]，P <0.001）。在观察到的 2469 例实际患者 CVC 更换敷料中，彩排培训师需要的纠正提示更少（9%与 21%，P <0.001），研究期间医院 CLABSI 率从 5.3/1000 降至 2.9/1000 导管日（P <0.001）。
该计划提高了护士在人体模型上的知识、自我信心和运动技能表现（例如，T1 结果）。这些改进与实际患者程序能力的提高（T2 结果）以及与医院 CLABSI 率降低的时间相关性（T3 结果）相关。
Zotero 插件