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A1047
October 19, 2019
10/19/2019 1:15:00 PM - 10/19/2019 3:15:00 PM
Room WA2 - Area C
Educating Perioperative Nurses About Local Anesthetic Systemic Toxicity Using Hi-fidelity Simulation
Kristin Bevil, M.D., Shelly B. Borden, M.D., Lisa Klesius, M.D.
University of Wisconsin, Madison, Wisconsin , United States
Disclosures: K. Bevil: None.S.B. Borden: None.L. Klesius: None.
IntroductionPerioperative crisis management requires a multidisciplinary approach to resuscitate a patient from potentially fatal physiology. Perianesthetic catastrophic events are incredibly rare. However, this rarity creates a challenge in training staff to help facilitate rapid treatment of emergencies, such as local anesthetic systemic toxicity (LAST). Due to varying definitions of major and minor episodes of LAST as well as use of ultrasound techniques, the incidence of LAST is difficult to ascertain, but this complication remains a rare, but clinically significant event. Oftentimes, nursing staff are the healthcare providers spending the most time at the patient bedside following a regional anesthetic procedure. Adequate clinical judgment is vital to the early detection of potential LAST, notification of the physician, and administration of lipid emulsion. Simulation learning offers a unique venue to encounter rare events while also practicing nontechnical skills. Even a single, targeted simulation session can be beneficial. Thus, this study aimed to evaluate knowledge retention regarding LAST in perianesthetic nursing staff utilizing high fidelity simulation and a short didactic session.MethodsAfter obtaining IRB approval, 13 nurses from the regional anesthesiology team, the preoperative unit, and the post-anesthesia care unit participated in the study. The intervention consisted of a high-fidelity simulation session in which the nurses had to care for a patient who experiences LAST after a paravertebral block, demonstrated by seizure and cardiovascular collapse, with successful resuscitation after administration of lipid emulsion. Following the simulation, the subjects participated in a formal debrief followed by a short lecture. Participants were assessed with a multiple choice test, administered immediately pre-simulation, post-lecture, 1 month, and 3 month post-simulation. A questionnaire addressing self-efficacy, change in skill level, and comfort in crisis management was included with the 1 month assessment.ResultsComplete data was analyzed for 12 subjects. Test scores, compared to the pre-test, significantly improved on the immediately post, 1 month, and 3 month assessments (p<0.0001). Test scores decreased slightly from the post-test to the 1 month assessment, but remained stable at the 3 month assessment (p=0.024, p=0.79). Overall organization, administration, and content of the simulation scenario were reviewed favorably. Participants felt more equipped to handle crisis management scenarios, and most were able to apply information learned into their everyday practice. One hundred percent of respondents would recommend the simulation experience to a colleague.ConclusionsExperiential learning often results in greater knowledge acquisition and retention. Participants in this study improved their test scores regarding local anesthetic systemic toxicity as well as increased their sense of self-efficacy and ability to handle crisis scenarios after taking part in a high-fidelity simulation. Further, this study promoted a sense of multidisciplinary, team-based care in our perioperative setting.$$graphic_{CAEC0FA3-F1B4-44B0-92DA-418108902513}$$$$graphic_{0AA1DC20-77D3-4809-B2B4-D1581C07A710}$$
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