Singleton Marcy N, Allen Kimberly F, Li Zhongze, McNerney Kevin, Naber Urs H, Braga Matthew S
Pediatric Critical Care Medicine, Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire.
Norris Cotton Cancer Center, Biostatistics Shared Resource, Dartmouth College, Hanover, New Hampshire.
BMJ Simul Technol Enhanc Learn. 2018 Apr;4(2):77-82. doi: 10.1136/bmjstel-2017-000243. Epub 2017 Sep 25.
Paediatric Intensive Care Unit Nurses (PICU RNs) manage the code cart during paediatric emergencies at the Children's Hospital at Dartmouth-Hitchcock. These are low -frequency, high-stakes events.
An uncontrolled intervention study with 6-month follow-up. A collaboration of physician and nursing experts developed a rolling-refresher training programme consisting of five simulated scenarios, including 22 code cart skills, to establish nursing code cart competency. The cohort of PICU RNs underwent a competency assessment in training 1. To achieve competence, the participating RN received immediate feedback and instruction and repeated each task until mastery during training 1. The competencies were repeated 6 months later, designated training 2.
Thirty-two RNs participated in training 1. Sixteen RNs (50%) completed the second training. Our rolling-refresher training programme resulted in a 43% reduction in the odds of first attempt failures between training 1 and training 2 (p=0.01). Multivariate linear regression evaluating the difference in first attempt failure between training 1 and training 2 revealed that the following covariates were not significantly associated with this improvement: interval Paediatric Advanced Life Support training, interval use of the code cart or defibrillator (either real or simulated) and time between training sessions. Univariate analysis between the two trainings revealed a statistically significant reduction in first attempt failures for: preparing an epinephrine infusion (72% vs 41%, p=0.04) and providing bag-mask ventilation (28% vs 0%, p=0.02).
Our rolling-refresher training programme demonstrated significant improvement in performance for low-frequency, high-risk skills required to manage a paediatric code cart with retention after initial training.
在达特茅斯-希区柯克儿童医院，儿科重症监护病房护士（PICU RNs）在儿科急诊期间负责管理急救推车。这些是低频、高风险事件。
一项为期6个月随访的非对照干预研究。医生和护理专家合作制定了一个滚动复习培训计划，该计划由五个模拟场景组成，包括22项急救推车技能，以确立护理急救推车能力。PICU RNs队列在培训1中接受了能力评估。为达到能力要求，参与的注册护士在培训1期间获得即时反馈和指导，并重复每项任务直至掌握。6个月后重复进行能力评估，即培训2。
32名注册护士参加了培训1。16名注册护士（50%）完成了第二次培训。我们的滚动复习培训计划使培训1和培训2之间首次尝试失败的几率降低了43%（p=0.01）。评估培训1和培训2之间首次尝试失败差异的多变量线性回归显示，以下协变量与这种改善没有显著关联：儿科高级生命支持培训间隔、急救推车或除颤器（实际或模拟）的使用间隔以及培训课程之间的时间。两次培训之间的单变量分析显示，以下方面首次尝试失败率有统计学显著降低：准备肾上腺素输注（72%对41%，p=0.04）和进行面罩通气（28%对0%，p=0.02）。
我们的滚动复习培训计划表明，对于管理儿科急救推车所需的低频、高风险技能，在初始培训后保持了能力，且表现有显著改善。
