Galos Michelle
Michelle Galos, DNP, APRN, AGACNP-BC, CCRN, is an acute care nurse practitioner with an interest in management of patients on ECMO, post cardiothoracic and transplant surgery, and patients with advanced heart failure requiring ventricular assist device support. She has experience starting two nurse-run ECMO programs for major medical centers in Chicago, IL.
Dimens Crit Care Nurs. 2022;41(3):124-131. doi: 10.1097/DCC.0000000000000522.
A major academic medical center in the Midwest has expanded their extracorporeal membrane oxygenation (ECMO) program from 8 ECMO cases in 2014 to 97 ECMO cases in 2017. The Extracorporeal Life Support Organization states that standardized policies, procedures, and standards of care are necessary for an ECMO center to be successful.
With the rapid growth of the ECMO program, this medical center has chosen to transition nurses and respiratory therapists into the role of ECMO specialist to bridge the gap in care created by the influx in patients. Currently, no specific set of policies/procedures or standards of care exist for ECMO patients. The primary objective of this study is to improve the self-efficacy of ECMO specialists and bedside nurses through the development of a comprehensive ECMO program that includes standardized policies and procedures, order sets, and evidence-based patient management guidelines.
METHODS/IMPLEMENTATION: The General Self-Efficacy Survey was used to assess the self-efficacy of both the ECMO specialists and the bedside nurses before implementation of the program. An ECMO manual was created that contained education on veno-arterial and veno-venous ECMO, policies and procedures, and patient management guidelines. An EPIC order set was created to ensure the correct protocols and management guidelines were ordered for all ECMO patients. Postimplementation self-efficacy surveys, direct observations, and chart audits occurred to assess program fidelity.
The self-efficacy was assessed of the ECMO specialists and beside nurses 4 months after implementation of policies, procedures, patient management guidelines, and an ECMO order set. The ECMO specialists' self-efficacy survey responses increased by 25% and the bedside nurses' self-efficacy survey responses increased by 27% after 4 months. Direct observation of ECMO specialist handoff to ensure protocol fidelity also occurred. There was a 40% increase in ECMO specialist handoff taking place and a 72% increase in ECMO circuit examination.
With the significant growth of ECMO patients, policies, protocols, and management guidelines are essential to provide safe care to these patients. There was a statistically significant improvement in the self-efficacy of both the ECMO specialists and bedside nurses. This was shown to directly correlate to an improvement in professional practice behaviors and ultimately improve the quality of patient care provided to ECMO patients.
美国中西部的一家大型学术医疗中心已将其体外膜肺氧合（ECMO）项目从2014年的8例ECMO病例扩大到2017年的97例。体外生命支持组织指出，标准化的政策、程序和护理标准对于一个成功的ECMO中心来说是必要的。
随着ECMO项目的迅速发展，这家医疗中心选择将护士和呼吸治疗师转变为ECMO专科医生的角色，以弥补患者涌入所造成的护理缺口。目前，针对ECMO患者尚无一套具体的政策/程序或护理标准。本研究的主要目标是通过制定一个全面的ECMO项目来提高ECMO专科医生和床边护士的自我效能感，该项目包括标准化的政策和程序、医嘱集以及循证患者管理指南。
方法/实施：在项目实施前，使用一般自我效能量表来评估ECMO专科医生和床边护士的自我效能感。创建了一本ECMO手册，其中包含关于静脉-动脉和静脉-静脉ECMO的教育内容、政策和程序以及患者管理指南。创建了一个EPIC医嘱集，以确保为所有ECMO患者开出正确的方案和管理指南。在实施后进行自我效能量表调查、直接观察和病历审核，以评估项目的依从性。
在实施政策、程序、患者管理指南和ECMO医嘱集4个月后，对ECMO专科医生和床边护士的自我效能感进行了评估。4个月后，ECMO专科医生的自我效能量表调查反馈增加了25%，床边护士的自我效能量表调查反馈增加了27%。还对ECMO专科医生的交接班进行了直接观察，以确保方案的依从性。ECMO专科医生的交接班增加了40%，ECMO回路检查增加了72%。
随着ECMO患者数量的显著增加，政策、方案和管理指南对于为这些患者提供安全护理至关重要。ECMO专科医生和床边护士的自我效能感有统计学意义的提高。这表明与专业实践行为的改善直接相关，并最终提高了为ECMO患者提供的护理质量。
