Does practical simulation increase the confidence of nurses working in recovery to manage deteriorating patients?

Background

Recovery nurses recover patients from anaesthesia and require advanced airway skills. Band 5 staff in recovery were asked to complete a questionnaire assessing confidence with deteriorating patients. Forty-two responses were received, 42.86% of staff felt confident to assist with an airway emergency/intubation despite 57.14% reporting involvement in such situations. 71.43% reported feeling confident to assist with a cardiac arrest. As there was a higher reported incidence of airway complications and a lower confidence level this was the focus of the project and simulations focused on the use of airway equipment whilst managing a deteriorating patient. Due to differences in staff experience levels both one to one and group simulation were trialled.

Aim

Improve recovery staff confidence to assist with post-operative airway emergencies by 40% within 6 months.

Method

Fishbone analysis was used to populate a driver diagram and identify changes ideas within recovery with the aim of improving staff confidence. PDSA cycles were carried out which were emergency equipment standardisation, one to one simulation sessions and a group simulation session.

Results

PDSA1) 50% of respondents reported feeling confident to assist with intubation following the change which was an increase of 7.14%. Minor change in confidence following equipment changes.

PDSA2) 100% participants reported increased confidence which was an increase of 57.14%, however only 6 people received the one-to-one training during the study period.

PDSA3) 93.75% of respondents reported feeling confident following the training which was an increase of 50.89% from baseline data

Lessons Learnt

Simulation training was found to improve staff confidence however, no ongoing data to confirm that this was a sustainable increase without regular training and monitoring. The difficulties of delivering regular simulation training within a busy department is acknowledged and requires further assessment and planning in order to be sustainable.

Next steps

Run further training sessions and secure protected training time. Consider multidisciplinary simulations.