The Western Pennsylvania Hospital (WPH)’s Cardiovascular (CV) Institute was closed for 18 months, undergoing a $9 million renovation. Prior to reopening the unit, 12 simulation courses were held in-situ to assess the nursing staff’s knowledge on policies and procedures and to evaluate the physical layout of the new space. Simulations involved either transferring patients (to the Progressive Care Unit (PCU)), receiving patients (from LifeFlight, from the Emergency Department, from the Operating Room, from the PCU and from the Catheter Lab), or treating patients (assisting with a pericardial window; assisting with chest tube insertion; participating with an Emergent Open Sternotomy procedure after cardiac surgery; performing IABP troubleshooting assessments; initiating Hypothermia protocol; and performing hemodynamic assessments). These simulations represented common and/or high-risk situations to prepare the CV nurses in providing safe, efficient, patient-centered quality care while simultaneously allowing the staff to become familiar with their new environment.
Although the specific simulation purposes varied, they were all done in a similar fashion, with the goal of standardization of care and zero work process errors. They each began with the facilitator describing the current situation and history of the "patient," i.e. the simulator, to the CV staff participants and then a nurse or a group of nurses were asked to intervene and subsequently transfer, receive or treat the "patient." During the simulations, the course facilitator would complete a standardized yes/no checklist to monitor that each step of the procedure was properly done. The course facilitator would also rate the nurse or nurses’ non-technical skills of task management, communication/teamwork, leadership and situation awareness on 5-point Likert scales that ranged from "very poor" to "very good." The course facilitator also rated the nurse or nurses’ ability to ensure the patients’ comfort and their overall performance on that same 5-point Likert scale. Participants were debriefed after each individual simulated scenario and then all of the CV ICU nurses were debriefed collectively after the entire set of 12 simulations were finished. Upon completion of the simulations, participants were deemed simulated competent. However, if the CV ICU staff still felt uncomfortable in performing various skills, they were welcome to use the simulation center in an open lab format for additional training.
As a result of these simulations, the CV nurses had an opportunity to get acquainted with their new workspace while also practicing various procedures. The course facilitator has two suggestions for other simulation centers who wish to create similar programs. First, he stressed the importance of recreating each scenario with the equipment used in real life situations in order to accurately assess nurses’ abilities to transfer theoretical knowledge to clinical competency. Second, he asserted that it would be ideal to include professionals from other disciplines such as respiratory, perfusion and operating room staff and surgeons in all of the simulations to consistently add more realism. For example, if the Operating Room Coordinator would have been included in the simulations, he/she would have brought his/her knowledge of the nuances of the surgeons and the particularities of the equipment and instruments that they prefer. He also recommended practicing as much as possible before the new unit opens. Practice turns a novice into a proficient practitioner and repetitive training improves precision. Never stop practicing. Therefore, even after the lab has opened, more simulations will be offered to the CV ICU nurses for continued competency monitoring. In particular, the open chest simulation will be offered to the CV ICU staff again in the future as this is a rare event and has the greatest impact on patient safety.
© 2013 by Lippincott Williams & Wilkins, Inc.