Standardization of Health Care Provider Competencies for Intrathecal Access Procedures. (November 2014)

• Record Type: Journal Article
• Authors: McLaughlin, Colleen A.; Hockenberry, Marilyn J.; Kurtzberg, Joanne; Hueckel, Rémi; Martin, Paul L.; Docherty, Sharron L.
• Is Part Of: Journal of pediatric oncology nursing. Volume 31:Number 6(2014:Nov./Dec.)
• Page Start: 304
• Page End: 316
• Publication Date: 2014-11
• Subjects: diagnostic lumbar puncture -- therapeutic lumbar puncture -- intrathecal chemotherapy -- skill decay -- confirmation bias; Cancer in children -- Periodicals; Pediatric nursing -- Periodicals; 618.92994
• DOI: 10.1177/1043454214543019
• Languages: English
• ISSNs: 1043-4542

Abstract

Introduction: This quality improvement (QI) project addresses a method for experienced health care providers to maintain skill-based competence for intrathecal access procedures.Methods: A prospective QI design using intrathecal access simulation to assess, educate, and evaluate skill competency. Simulation was used as a strategy to promote patient safety and standardize practice patterns. Pretest and posttest methodology using paired t tests were performed to assess anxiety, confidence, and knowledge.Results: Fourteen pediatric providers participated in this QI project. There was a statistically significant improvement in confidence measuring intracranial pressure (ICP; t = −2.92, P = .013), performance-related overall anxiety ( t = −2.132, P = .05) and administering intrathecal chemotherapy ( t = −2.144, P = .053). Fifty percent of participants missed a medication error demonstrating confirmation bias.Conclusion: This simulation strategy resulted in improved confidence in measuring ICP, performance-related overall anxiety, and confidence in administering chemotherapy. Confirmation bias occurred during simulation testing for a medication error. We propose this method for maintaining clinical competencies in health care providers and introducing new skills to existing practices.