J Obstet Gynecol Neonatal Nurs. 2020 May;49(3):272-282. doi: 10.1016/j.jogn.2020.01.006. Epub 2020 Feb 23.
To test the hypothesis that capping intravenous and epidural lines would reduce time to transfer women in labor to the operating room and time to readiness for general anesthesia for emergency cesarean. The secondary purpose was to identify latent threats to patient safety.
Mixed methods analysis of a randomized, controlled, in situ simulation trial.
Labor and delivery unit at high-risk referral center.
Fifteen interprofessional teams that included labor and delivery nurses and anesthesiology residents.
Immediately before simulation, we randomized bedside nurses and anesthesiology residents to one of two groups: usual transfer or the cap and run procedure. Simulation scenarios started with fetal heart rate decelerations that necessitated position changes followed by emergency cesarean. An embedded simulated obstetrician announced the decision for cesarean; completion of an OR checklist confirmed team readiness to induce general anesthesia. Postsimulation debriefing was focused on teamwork and opportunities to improve safety, and we used qualitative analysis to synthesize results.
We found no statistically significant difference in the overall time from decision for cesarean to readiness for general anesthesia between the two groups (usual transfer median = 445 seconds [interquartile range, 425-465] vs. cap and run 390 seconds [interquartile range, 383-443], p = .12). The time in the operating room was less in the cap and run group than in the usual transfer group (median = 300 seconds vs. 250 seconds, p = .038). Qualitative analysis of the debriefing data indicated advantages of the capping procedure, including better bed maneuverability and fewer tangled lines.
We found no evidence of decreased overall time from decision for cesarean to readiness for general anesthesia based on whether the nurse capped the intravenous and epidural lines or pushed the intravenous pole alongside the bed. However, nurses perceived improved patient safety with the cap and run procedure.
验证假设，即对静脉和硬膜外导管进行盖帽处理可以减少产妇转移至手术室的时间以及紧急剖宫产全麻准备就绪的时间。次要目的是识别对患者安全的潜在威胁。
随机、对照、现场模拟试验的混合方法分析。
高危转诊中心的产房和分娩室。
15 个由产科护士和麻醉住院医师组成的跨专业团队。
在模拟开始前，我们将床边护士和麻醉住院医师随机分为两组：常规转移或盖帽和奔跑程序。模拟场景从胎心减速开始，需要改变体位，随后进行紧急剖宫产。一位嵌入式模拟产科医生宣布进行剖宫产的决定；完成手术室检查表确认团队准备好诱导全身麻醉。模拟后讨论的重点是团队合作和提高安全性的机会，我们使用定性分析来综合结果。
我们发现两组之间从决定剖宫产到准备全身麻醉的总时间没有统计学上的显著差异（常规转移中位数为 445 秒[四分位距，425-465]与盖帽和奔跑 390 秒[四分位距，383-443]，p=0.12）。在手术室的时间，盖帽和奔跑组比常规转移组更短（中位数 300 秒与 250 秒，p=0.038）。讨论数据的定性分析表明盖帽程序具有优势，包括更好的床操作性和更少的缠结线。
我们没有发现根据护士是否盖帽静脉和硬膜外导管或将静脉杆推到床边，从决定剖宫产到准备全身麻醉的总时间会有所减少的证据。然而，护士认为盖帽和奔跑程序可以提高患者安全性。
