Authors (including presenting author) :
Lam YK(1), Tsang WM(1), Chan HW(1), Tung KL(1)(3), Lee HK(1)(4), Chan SP(1)(2), Law KF(1)
Affiliation :
(1)Medicine and Geriatrics, United Christian Hospital (2)Resuscitation Training Centre, United Christian Hospital (3)Li Ka Shing Institute of Professional and Continuing Education, The Open University of Hong Kong
(4)Resuscitation Training Centre, Caritas Medical Centre
Introduction :
Critically-ill patient transfer from coronary care unit (CCU) to other hospitals is a high risk procedure due to unstable patient condition and involvement of complex life-sustaining medical devices. In case of any adverse event, competency of the escorting nurse is of vital importance. Yet, the current training in our unit was unstandardized and KEC inter-hospital transfer (IHT) checklist was not tailor-made for CCU settings. To enhance clinical safety, we conducted a pilot programme involving a simulation-based IHT training and a modified CCU IHT checklist.
Objectives :
1. To enhance competency of nurses in managing adverse events during IHT through simulation-based training 2. To reduce risk in IHT of critically-ill patients from CCU with the modified checklist
Methodology :
A “Pre-test Post-test” design was adopted. Subjects were nurses with less than 5 years CCU experience. In pre-test, subjects were required to undergo the scenario without training and introduction of the modified checklist. In post-test, they were required to manage the same scenario one month after receiving the training and with the use of the modified checklist. The two components of the pilot programme were: 1) Simulation-based training An IHT scenario was simulated with manikin and equipment such as ventilator and intra-aortic balloon pump (IABP). Physiological parameters were simulated with a commercially available medical simulation programme to facilitate an interactive environment. Debriefing sessions were provided to enhance the learning process. 2) Modified checklist Items of common cardiac equipment and related quick reference for trouble-shooting were added on top of KEC IHT checklist. Outcome measures were nurses’ competencies in IHT including document preparation, patient preparation (general transfer preparation) and equipment handling. They were measured with competency audit forms which were validated and endorsed by CCU APN.
Result & Outcome :
Results: From April 2018 to December 2018, 2 samples were recruited. The mean of competency level in general transfer preparation, ventilator care and IABP care was increased by 28%, 15% and 12.5% respectively. Meanwhile, the percentage of missed critical items in general transfer preparation, ventilator care and IABP care was reduced by 25%, 0% and 100% respectively. There was a positive feedback from the participants towards the new checklist. Conclusions: This pilot programme improved the competency of junior nurses in managing IHT in a simulated environment. More subjects should be recruited to generate more reliable results. Further analysis should be done to examine its effects on real situation. In view of the future expansion in cardiac service in UCH, this pilot programme provides insight for further stimulated training for new staff.
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