Using Low Dose, High Frequency Simulation to Improve Skill Retention Among Pediatric Intensive Care Registered Nurses

Abstract

Background: The registered nurse (RN) and the respiratory therapist (RT) are integral parts of the care team in the PICU. The RTs are trained to become proficient in using a flow-inflating bag to provide bag-endotracheal tube (ETT) ventilation. The RN does not receive specialized training to adequately utilize the equipment.

Methods: A low dose, high frequency (LDHF) randomized study was conducted with 39 RNs with less than 2 years of PICU experience. The RNs were informed of what the study involved and signed consent to participate. The study was IRB approved. RNs were randomized into three groups: control group A, intervention group B, and intervention group C. All participants were provided an educational handout with steps to manually ventilate a patient with an ETT. Group B participated in 2 LDHF simulation sessions utilizing a manikin within the first and third month following the initial skills assessment. Group C participated in 5 LDHF simulation sessions utilizing a manikin on a monthly basis. Each RN was rated on their ability to properly use the flow-inflating bag for ETT ventilation. The skill assessment was based on 9 components with a score of 1-5, 5 being proficient. The assessor was blind to the assigned groups and interventions. Primary components included rapid patient assessment, safety and infection prevention, adjusting flow and PEEP, monitoring end-tidal CO₂ and oxygen saturations.

Results: Group A had an initial score of 63% and a follow up score of 66%. Group B had a pre-intervention score of 60% and a post score of 76%. Group C had a pre-intervention score of 63% and a post score of 80%. A one-way ANOVA determined the results to be statistically significant (P < .05). Pre-study comfort level was evaluated, 68% of the 39 RNs reported they were uncomfortable using the flow inflating bag. Following the intervention 11% of the RNs remained uncomfortable. Approximately 30% reported neutrality before and after the study, and overall comfort level rose from 4% to 53%.

Conclusions: Utilizing the LDHF simulation improved skill retention and comfort level. Continuing a culture of patient safety and interprofessional collaboration closed the gap for RNs between comfort and skill level. Education will be ongoing through skills lab with hands-on practice, interprofessional simulations with high-fidelity manikins, and accountability practices for continued patient safety.