Background/context The initiative stemmed from concerns raised by staff on the management of patients with VAD on a medical ward. Majority of the nurses have had training on the care of VAD in a clinical skills laboratory but felt lacking in competence in obtaining blood samples from lines.
Methodology The Project Team has decided to focus on blood sampling from a tunnelled central line and utilise in-situ hybrid simulation. This involved Chester Chest and a simulated patient. The objectives were to:
provide training update and opportunities to practice in a safe, non-threatening "environment" within the individual’s own working environment.
provide support to staff in identifying factors that promote or impede safe practice of the procedure.
Results The pilot consisted of 7 sessions of approximately 1.5 h each with 10 members of staff involved. Post simulation, the staff have expressed confidence on the procedure and have been accessing lines since. Where there have been areas of good practice and acceptable level of competence there were also areas that needed to be urgently addressed though debrief, feedback and deliberate practice. Other findings included: marked misuse equipment, unavailability of equipment at the point of use, poor adherence to blood sampling guidelines that would have caused serious pre-analytical errors, variances in the understanding of aseptic technique and attitudinal issues over using VAD. Latent conditions have also been identified: identical packaging of disinfection wipes, dirty air vent, space and temperature in the treatment room. Time wasters like the faulty printer and the disorganised stacker system has also been highlighted.
Conclusions and recommendations The initiative has increased staff competencies on accessing VAD thereby reducing risks of patient harm. It has also helped the department address latent conditions and time wasters.
Barsuk JH, Cohen ER, Feinglass J, et al. Use of simulation-based education to reduce catheter-related bloodstream infections. Archives of Internal Medicine 2003;169(15):1420–3
Department of Health (2007) High Impact Intervention No. 1 Central Venous Catheter Care Bundle. Department of Health. London
Loveday HP et. al. epic3: National Evidence-based Guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection 2014
Taylor JT. Using Low-Fidelity Simulation to Maintain Competency in Central Line Care. The Journal of the Association for Vascular Access 2012;17(1):31–7
- Category: Course or curriculum evaluation/innovation/integration
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