Evaluating and Obtaining Annual Competencies Utilizing Simulation in Pediatric Intensive Care
Stennett, Charles Randall
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Purpose: A pilot project was initiated in an 18 bed PICU to evaluate nurses' competencies using simulation. Competencies were selected based on staff needs assessment and a root-cause-analysis of critical incidents occurring over a 12 month period. These competencies included; IV starts, IO insertions, EKG interpretation, airway management (especially related to unplanned extubation), and communication (among team members). Staff were provided an orientation to the simulator and opportunities for practice prior to the competency assessment were made available within the unit. Scenarios were developed based on realistic situation and hospital quality indicators. An expert panel reviewed all scenarios to support reliability and validity. All simulations were conducted within the pediatric intensive care unit and lasted 20 minutes followed by debriefing. Methods: This descriptive, quasi- experimental study was a one-group design in which participants served as their own controls. Measurements included changes in learner self-efficacy as reflected on the difference from pre-to post scores using the Learner Self-Efficacy Scale. Individual decision-making scores were determined using the Lasater Clinical Judgment Rubic and knowledge levels were reflected through a multiple choice examination. Results: Data analysis revealed a decrease in post-simulation self- evaluation for self-efficacy and a direct correlation identified between experience in PICU and clinical judgment reflected in the Lastater Clinical Judgment Rubic. Two unexpected Latent Threats to Patient Safety (PTS) were identified and corrected. Conclusion: Simulation-based competency testing utilizing a validated tool provided objective data for performance evaluation that was positively received by the staff. Follow-up over the past 10 months has demonstrated a significant decrease in unplanned extubation.