APRN Nationwide Children’s Hospital, United States
Abstract:
Background: There is little to no data on procedural sedation performed by advance practice registered nurse (APRN) in the pediatric and adult congenital cardiac population. Our objective is to describe a training program combining didactic sessions with simulation to train acute care APRNs providing procedural sedation for the pediatric and adult congenital cardiac population in a cardiac intensive care unit. Additionally, we sought to demonstrate simulation as an effective tool for initial credentialing in lieu of a self-study module.
Methods: Current credentialing materials for the institution were reviewed and summarized into a didactic session. This included review of initial airway management, ASA classification, sedation medication review, and review of state and institutional regulations regarding APRN sedation practices. Goals of the didactic session and simulation were: 1) The provider would be able to identify target level of sedation, 2) Demonstrate appropriate selection of medications for intended target of sedation, 3) Identify potential risks of sedation in the patient population, and 4) Demonstrate ability to rescue the patient who exceeds intended sedation target. Participants completed a pre-test prior to the didactic session and an online post-test completed 2 weeks after the course. During the simulation, participants interacted with Cardiac ICU APRN and Physician simulation faculty. A checklist was followed by simulation staff to ensure that all participants identified ASA classification, risks, and planned level of sedation prior to stating the session. Participants then progressed through three simulated sedations. These included infant and pediatric patients with congenital heart disease as well as an adult congenital patient with additional risk factors. Finally, a representative from the anesthesia and credentialing team observed these sessions and reviewed the materials for approval as a method for credentialing.
Results: Fifteen Acute Care Cardiac Intensive Care APRNs participated in the didactic and simulation sessions. All fifteen completed the simulation checklists with satisfactory performance as evaluated by the simulation faculty. Each Participant completed pre- and post-session surveys. The average test score went from 57 percent pre-course to 85% after completion of the course.
Conclusions: Didactic sessions in combination with high fidelity simulation was found to be an effective approach in training acute care APRNs in procedural sedation of pediatric and adult congenital patients within a cardiac intensive care unit. The course demonstrated an improvement in APRN knowledge and retention of information. Additionally, the course was presented by the anesthesia representative to the medical staff office based on these findings and was approved as a method for both initial credentialing as well as future recredentialing for APRNS.
