Background The old adage of procedural skills training ‘see one, do one, teach one’ has now been replaced by “See one, teach one, do many, harm no one”1. The NICU at Southampton caters to 160 babies annually who may need airway support and umbilical access soon after birth. With reduced time in training a balance has to be struck between high risk procedures in vulnerable babies and skill acquisition. In 2011–12 there were significant issues with ET (Endotracheal) tube slippage and umbilical catheter extravasations resulting in morbidity and mortality.
Technical Innovation: OPEN (Observation, Perception, Experiential LearNing) Approach.
Workshops covering airway management and vascular access have been introduced (2012). These are run within 6 weeks of starting. The airway workshop focusses on the intubation and fixation of ET tube followed by supervised practice in a high fidelity mannequin. The access workshop starts with aseptic technique, actual videos of the procedures, a practical demonstration and finally performing the procedure. The workshops are followed by a simulated Multiprofessional scenario to reinforce the above complications.
Outcomes Deliberate practice of intubation and fixation has eradicated ET tube slippage. Umbilical catheter extravasations have been reduced by 50% (4.5% vs 2.2% vs 0% p = 0.1) from 2012 to 2014. Serious extravasation related complications (Death, Ascites, and Intracranial haemorrhage) have been reduced from 3.1% to 0% (p = 0.03).
Take Home Messages: While use of task trainers is common, this approach provides visual, tactile, perceptual and experiential learning to cover all learner types. A focus on technique, consistent approach, asking for help and emphasising how deviation from the norm can result in complications has made an improvement in clinical outcomes. The Multiprofessional scenarios put the complications encountered in clinical context while raising awareness of risk issues with new staff and nurses in a simulated multidisciplinary environment.
‘Rodriguez-Paz JM, Kennedy M, Salas E, Wu AW, Sexton JB, Hunt EA, et al. Beyond “see one, do one, teach one”: toward a different training paradigm. Quality and Safety in Health Care 2009; 18(1):63–8
Templeton J.: A Review of the Impact of European Working Time Directive on the Quality of Training. England, Medical Education 2010
- Category: Course or curriculum evaluation/innovation/integration
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